Gage Medical Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

NP437634 Issued in CA

Legal business name

GAGE MEDICAL CLINIC INC

Doing business as

Clinica Virgen de Guadalupe
gAGE mEDICAL cLINIC iNC.

Practice address

985 W Vernon Ave
Los Angeles, CA 90037-3038

Phone

(323) 234-6300

NPI assigned

Jan 14, 2009

Last updated

Jan 19, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

GAGE MAEDICAL CLINIC INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Odilia Walsh

Title

Administrator

Phone

(562) 706-2433

Specialties & licenses 14

Addresses

Other names 2

• CLINICA VIRGEN DE GUADALUPE Doing business as
• gAGE mEDICAL cLINIC iNC. Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Gage Medical Clinic Inc3 organizations share this tax ID, including this one

Part of

Gage Medical Clinic Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Gage Medical Clinic Inc

  dba Pacoima Medical Center

  • Family Medicine Physician
  • Pacoima, CA
  • NPI 1114053279
  NPD tax ID
• Gage Medical Clinic Inc

  dba Mother Theresa Medical Center of Huntington Park

  • General Practice Physician
  • Huntington Park, CA
  • NPI 1477069375
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Keech, M.D.

  • Family Medicine Physician
  • Huntington Park, CA
  • NPI 1487748364
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1003053943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 W VERNON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373038",
            "telephone_number": "323-234-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 W VERNON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373038",
            "telephone_number": "323-234-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAGE MEDICAL CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GAGE MAEDICAL CLINIC INC",
        "enumeration_date": "2009-01-14",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "ODILIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "562-706-2433"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G29047",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA20034",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A67659",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA19004",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA18238",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA17459",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "NP437634",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "PA18238",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "PA17459",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A67659",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "RN437634",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "PA19004",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "PA20034",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G29047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLINICA VIRGEN DE GUADALUPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "gAGE mEDICAL cLINIC iNC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Giovanna Gaetani
• Sheema Gaffar, MD
• Jimmy Lee Gaffeney Jr.
• Dorhean Cornileus Gaffney
• Timothy Gagan, PTA
• Diana L Gage, M.D., PH.D.
• Laina Gagliardi
• Laura Gagliardi
• Serge Gagnon, DC
• Julie Gahret

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.