| Santa Rosa De Lima Medical Clinic Inc. | |
|
6915 Seville Ave Huntington Park CA 90255-4901 | |
| (323) 588-9800 | |
| Not Available |
| Full Name | Santa Rosa De Lima Medical Clinic Inc. |
|---|---|
| Speciality | General Practice |
| Location | 6915 Seville Ave, Huntington Park, California |
| Authorized Official Name and Position | Edwin Zevallos (PHYSYCIAN) |
| Authorized Official Contact | 3235889800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Rosa De Lima Medical Clinic Inc. 6915 Seville Avenue Huntington Park CA 90255 Ph: (323) 588-9800 | Santa Rosa De Lima Medical Clinic Inc. 6915 Seville Ave Huntington Park CA 90255-4901 Ph: (323) 588-9800 |
| NPI Number | 1821139205 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9436180817 |
|---|---|
| Medicare Enrollment ID | O20050825000402 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821139205 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A53394 (California) | Primary |
| Provider Name | Edwin Werner Zevallos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518042498 PECOS PAC ID: 3971534355 Enrollment ID: I20110415000225 |
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