| Clinica Del Socorro Medical Group,inc. | |
|
1061 E Vernon Ave Suite 'f' Los Angeles CA 90011-3772 | |
| (323) 233-9686 | |
| (323) 233-0595 |
| Full Name | Clinica Del Socorro Medical Group,inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1061 E Vernon Ave, Los Angeles, California |
| Authorized Official Name and Position | Patrick B. Lawrence (DIRECTOR) |
| Authorized Official Contact | 3232339686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Del Socorro Medical Group,inc. 1061 E Vernon Ave Suite 'f' Los Angeles CA 90011-3772 Ph: (323) 233-9686 | Clinica Del Socorro Medical Group,inc. 1061 E Vernon Ave Suite 'f' Los Angeles CA 90011-3772 Ph: (323) 233-9686 |
| NPI Number | 1215263827 |
|---|---|
| Provider Enumeration Date | 11/02/2009 |
| Last Update Date | 11/18/2009 |
| Medicare PECOS PAC ID | 9032254404 |
|---|---|
| Medicare Enrollment ID | O20100310000247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215263827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C39153 (California) | Primary |
| 208D00000X | General Practice | A20149 (California) | Secondary |
| Provider Name | Patrick B Lawrence |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578625364 PECOS PAC ID: 4789674672 Enrollment ID: I20040513000704 |
| Provider Name | Gaston C Herrera |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1952528002 PECOS PAC ID: 0446225668 Enrollment ID: I20040831001388 |
| Provider Name | Byron Flores |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881601383 PECOS PAC ID: 0042258139 Enrollment ID: I20050511000367 |
| Provider Name | Edgar I Martinez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1336163294 PECOS PAC ID: 2264591437 Enrollment ID: I20081103000110 |
| Provider Name | Kathy Wilson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1245490721 PECOS PAC ID: 5496903957 Enrollment ID: I20120907000458 |
| Provider Name | Dimas Giovanni Calvachi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386143881 PECOS PAC ID: 3375804305 Enrollment ID: I20180307001660 |
| Provider Name | Francis Chukwuemeka Obi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841659174 PECOS PAC ID: 7416241005 Enrollment ID: I20230601001152 |
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