Echo Park Family Medical Clinic | |
1160 N Logan Street Los Angeles CA 90026 | |
(213) 250-7069 | |
(213) 250-7520 |
Full Name | Echo Park Family Medical Clinic |
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Speciality | General Practice |
Location | 1160 N Logan Street, Los Angeles, California |
Authorized Official Name and Position | Jose De Guzman Co Ting (PRESIDENT) |
Authorized Official Contact | 2132507069 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Echo Park Family Medical Clinic 2140 Camino San Rafael Glendale CA 91206 Ph: (818) 952-4118 | Echo Park Family Medical Clinic 1160 N Logan Street Los Angeles CA 90026 Ph: (213) 250-7069 |
NPI Number | 1942218730 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 04/19/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942218730 | NPI | - | NPPES |
00A388250 | Other | CA | CHDP |
00A388250 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | A38825 (California) | Primary |
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