| Eastside Family Clinic | |
|
321 S Mednik Ave Los Angeles CA 90022-1839 | |
| (323) 261-4706 | |
| (323) 261-4124 |
| Full Name | Eastside Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 321 S Mednik Ave, Los Angeles, California |
| Authorized Official Name and Position | Enrique J. Gonzalez (PRESIDENT) |
| Authorized Official Contact | 3232614706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Family Clinic 321 S Mednik Ave Los Angeles CA 90022-1839 Ph: (323) 261-4706 | Eastside Family Clinic 321 S Mednik Ave Los Angeles CA 90022-1839 Ph: (323) 261-4706 |
| NPI Number | 1568656791 |
|---|---|
| Provider Enumeration Date | 08/30/2007 |
| Last Update Date | 03/29/2022 |
| Medicare PECOS PAC ID | 4486058369 |
|---|---|
| Medicare Enrollment ID | O20210816000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568656791 | NPI | - | NPPES |
| 00G747901 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | G74790 (California) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Enrique J Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023161684 PECOS PAC ID: 2860540135 Enrollment ID: I20090427000292 |
| Provider Name | Teresa Sifuentes Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073665998 PECOS PAC ID: 1658330105 Enrollment ID: I20111213000194 |
| Provider Name | Mary D Painaga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619528403 PECOS PAC ID: 2567892953 Enrollment ID: I20200427001816 |
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