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2040 Pacific Coast Hwy Suite S Lomita CA 90717-2660 | |
| (424) 347-8008 | |
| (844) 481-9664 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2040 Pacific Coast Hwy, Lomita, California |
| Authorized Official Name and Position | Roderick P Ramos (COO) |
| Authorized Official Contact | 4243478008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2040 Pacific Coast Hwy Suite S Lomita CA 90717-2660 Ph: (424) 347-8008 | 2040 Pacific Coast Hwy Suite S Lomita CA 90717-2660 Ph: (424) 347-8008 |
| NPI Number | 1346607603 |
|---|---|
| Provider Enumeration Date | 01/18/2016 |
| Last Update Date | 02/09/2022 |
| Medicare PECOS PAC ID | 5698068120 |
|---|---|
| Medicare Enrollment ID | O20160721001306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346607603 | NPI | - | NPPES |
| A25005 | Other | CA | MANUEL BACULI MD |
| PA19706 | Other | CA | RODERICK P RAMOS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Fatima Bicenio Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477133668 PECOS PAC ID: 1355736299 Enrollment ID: I20220311001443 |
| Provider Name | Ivy Rose Malit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750048708 PECOS PAC ID: 9436544228 Enrollment ID: I20220314001059 |
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