| San Martin De Porres Medical Clinic Of South Gate, Inc | |
|
10001 California Ave South Gate CA 90280-6005 | |
| (323) 564-4408 | |
| (323) 564-9641 |
| Full Name | San Martin De Porres Medical Clinic Of South Gate, Inc |
|---|---|
| Speciality | General Practice |
| Location | 10001 California Ave, South Gate, California |
| Authorized Official Name and Position | Ana Consiglieri (SUPERVISOR) |
| Authorized Official Contact | 3235644408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Martin De Porres Medical Clinic Of South Gate, Inc 10001 California Ave South Gate CA 90280-6005 Ph: (323) 564-4408 | San Martin De Porres Medical Clinic Of South Gate, Inc 10001 California Ave South Gate CA 90280-6005 Ph: (323) 564-4408 |
| NPI Number | 1134298318 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 10/06/2014 |
| Medicare PECOS PAC ID | 3971539941 |
|---|---|
| Medicare Enrollment ID | O20050711000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134298318 | NPI | - | NPPES |
| GR0061920 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jose M Torreblanca |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407922107 PECOS PAC ID: 1850462797 Enrollment ID: I20080619000522 |
| Provider Name | Jose F Torreblanca |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871619346 PECOS PAC ID: 5193801769 Enrollment ID: I20100113000019 |
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