| San Juan Medical Group | |
|
2933 Whittier Blvd Los Angeles CA 90023-1528 | |
| (323) 263-2669 | |
| (323) 263-2673 |
| Full Name | San Juan Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2933 Whittier Blvd, Los Angeles, California |
| Authorized Official Name and Position | Jose Sergio Sandoval (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 5627165620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Medical Group 2933 Whittier Blvd Los Angeles CA 90023-1528 Ph: (323) 263-2669 | San Juan Medical Group 2933 Whittier Blvd Los Angeles CA 90023-1528 Ph: (323) 263-2669 |
| NPI Number | 1710261284 |
|---|---|
| Provider Enumeration Date | 10/03/2011 |
| Last Update Date | 03/12/2020 |
| Medicare PECOS PAC ID | 0042473779 |
|---|---|
| Medicare Enrollment ID | O20120516000611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710261284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A60865 (California) | Primary |
| 208000000X | Pediatrics | A73468 (California) | Secondary |
| Provider Name | Maria Lourdes C De Leon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285775437 PECOS PAC ID: 3971685355 Enrollment ID: I20080123000858 |
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