| San Lucas Medical Clinic, Inc. | |
|
2010 Wilshire Blvd Suite 2012 Los Angeles CA 90057-3507 | |
| (213) 989-1535 | |
| (213) 989-1843 |
| Full Name | San Lucas Medical Clinic, Inc. |
|---|---|
| Speciality | General Practice |
| Location | 2010 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Vital Hinojosa (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3105219725 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Lucas Medical Clinic, Inc. 2010 Wilshire Blvd Suite 2012 Los Angeles CA 90057-3507 Ph: (213) 989-1535 | San Lucas Medical Clinic, Inc. 2010 Wilshire Blvd Suite 2012 Los Angeles CA 90057-3507 Ph: (213) 989-1535 |
| NPI Number | 1114231354 |
|---|---|
| Provider Enumeration Date | 07/29/2010 |
| Last Update Date | 05/31/2013 |
| Medicare PECOS PAC ID | 2567641558 |
|---|---|
| Medicare Enrollment ID | O20110124000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114231354 | NPI | - | NPPES |
| ED251A | Other | CA | MEDICARE PTAN |
| 1396874202 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A37463 (California) | Primary |
| Provider Name | Vital Hinojosa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1396874202 PECOS PAC ID: 9335042837 Enrollment ID: I20040130001096 |
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