NPIMap

Organization Active NPI

Clinica Monsignor Oscar a. Romero

  • Federally Qualified Health Center (FQHC)
  • Van Nuys, CA
National Provider Identifier
1053047670
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLINICA MONSIGNOR OSCAR A. ROMERO
Practice address
6330 Van Nuys Blvd Unit a
Van Nuys, CA 91401-2610
Phone
(818) 994-9822
Fax
(818) 994-9821
NPI assigned
Jul 26, 2022
Last updated
Jul 26, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINICA MONSIGNOR OSCAR A. ROMEROAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Romeo V Herrera
Title
Director of Compliance
Phone
(310) 407-9331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

6330 Van Nuys Blvd Unit a
Van Nuys, CA 91401-2610

Mailing address

6330 Van Nuys Blvd Unit a
Van Nuys, CA 91401-2610
Phone (818) 994-9822

Other practice location 1

21013 Sherman Way Ste 4
Canoga Park, CA 91303-3675
Phone (818) 887-9697

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241224000630 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264490218 Practice locations: Van Nuys, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053047670. Details of each certification follow.

Federally qualified health center certification: CCN A01909

Legal name
CLINICA MONSIGNOR OSCAR A. ROMERO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 28, 2025
Last certification
Jan 28, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
6330 Van Nuys Blvd
Unit a
Van Nuys, CA 91401-2610

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clinica MSR Oscar a Romero12 organizations share this tax ID, including this one
Part of
Clinica MSR Oscar a Romero

Other organizations with this tax ID 11

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

Locations

6330 Van Nuys Blvd
#A
Van Nuys, CA 91401
Phone (213) 989-7700

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marin Castillo Individual Corporate DirectorVice President of the Board Jan 1, 2022
Armando Carranza Individual Corporate DirectorSecretary of the Board Jan 1, 2022
Jose Hernandez Individual Corporate OfficerTreasurer of the Board Jan 1, 2022
Jose Ruiz Individual Corporate DirectorBoard of Director Jan 1, 2022
Mario Hercules Individual Corporate DirectorBoard Off Director Jan 1, 2022
Sandra Gonzalez Individual Corporate OfficerBoard of Director Jan 1, 2022
Santos Fernandez Individual Corporate OfficerBoard of Director Jan 1, 2022
Lizeth Chicas Individual Corporate OfficerBoard of Director Jan 1, 2022
Sonia Molina Individual Corporate OfficerPresident of the Board Jan 1, 2024
Carlos Hernandez Vaquerano Individual W-2 Managing EmployeeAd; Oct 1, 2018 100%
Operational/Managerial ControlChief Executive Officer Oct 1, 2018 100%

NPI Registry JSON

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1053047670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6330 VAN NUYS BLVD UNIT A",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012610",
            "telephone_number": "818-994-9822",
            "fax_number": "818-994-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6330 VAN NUYS BLVD UNIT A",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012610",
            "telephone_number": "818-994-9822",
            "fax_number": "818-994-9821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21013 Sherman Way Ste 4",
            "address_purpose": "LOCATION",
            "city": "Canoga Park",
            "state": "CA",
            "postal_code": "913033675",
            "country_code": "US",
            "telephone_number": "818-887-9697",
            "fax_number": "818-887-9495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINICA MONSIGNOR OSCAR A. ROMERO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINICA MONSIGNOR OSCAR A. ROMERO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "ROMEO",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "310-407-9331"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.