| Guadalupe Medical Group | |
|
1711 W Temple St Ste 5658 Los Angeles CA 90026-7337 | |
| (323) 543-4535 | |
| Not Available |
| Full Name | Guadalupe Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1711 W Temple St Ste 5658, Los Angeles, California |
| Authorized Official Name and Position | Teodulo Cruz Bonzon (OPERATING PROVIDER) |
| Authorized Official Contact | 8188464469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guadalupe Medical Group 4525 Eagle Rock Blvd Los Angeles CA 90041-3214 Ph: (818) 846-4469 | Guadalupe Medical Group 1711 W Temple St Ste 5658 Los Angeles CA 90026-7337 Ph: (323) 543-4535 |
| NPI Number | 1053902734 |
|---|---|
| Provider Enumeration Date | 01/27/2021 |
| Last Update Date | 01/27/2021 |
| Medicare PECOS PAC ID | 1456751775 |
|---|---|
| Medicare Enrollment ID | O20210608002458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053902734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Syed M G Hossain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083787907 PECOS PAC ID: 9436165404 Enrollment ID: I20070410000734 |
| Provider Name | Ajmal Mohammad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700017712 PECOS PAC ID: 2365570504 Enrollment ID: I20100510000669 |
| Provider Name | Roni B Maccabee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093931115 PECOS PAC ID: 7416363866 Enrollment ID: I20210309002439 |
| Provider Name | Teodulo Cruz Bonzon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497039192 PECOS PAC ID: 0446650766 Enrollment ID: I20210614001889 |
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