| Pico Clinica Medica Latina, A Medical Group, Inc | |
|
1600 W Pico Blvd Los Angeles CA 90015-2410 | |
| (213) 386-5252 | |
| (213) 386-5323 |
| Full Name | Pico Clinica Medica Latina, A Medical Group, Inc |
|---|---|
| Speciality | General Practice |
| Location | 1600 W Pico Blvd, Los Angeles, California |
| Authorized Official Name and Position | Teresita Alonzo Zareno (VICE PRESIDENT) |
| Authorized Official Contact | 2133865252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pico Clinica Medica Latina, A Medical Group, Inc 1600 W Pico Blvd Los Angeles CA 90015-2410 Ph: (213) 386-5252 | Pico Clinica Medica Latina, A Medical Group, Inc 1600 W Pico Blvd Los Angeles CA 90015-2410 Ph: (213) 386-5252 |
| NPI Number | 1740329101 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 12/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740329101 | NPI | - | NPPES |
| GR0082120 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A39524 (California) | Secondary |
| 208D00000X | General Practice | A40110 (California) | Primary |
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