Clinica Medica Mi Salud, Inc.
Organization Active NPI Family Medicine Physician · La Puente, CA
NPI 1104645282 · NPPES record last updated Oct 7, 2024
Key facts
- NPI
- 1104645282
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CLINICA MEDICA MI SALUD, INC.
- Practice address
- 1840 N Hacienda Blvd Ste 3
La Puente, CA 91744-1143 - Phone
- (626) 350-7087
- NPI assigned
- Oct 7, 2024
- Organization subpart
- No
Authorized official
- Name
- Lorenzo Vazquez, MD
- Title
- Ceo
- Phone
- (626) 422-5958
Practitioners 1
-
Lorenzo Vazquez, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2315245 | Clinica Medica Mi Salud, Inc | Certificate of waiver | Dec 8, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241203001792 | CA | Part B Supplier - Clinic/Group Practice | 7214462076 |
Receives reassigned benefits from 1 practitioner Practice locations: La Puente, CA; Paramount, CA |
National Provider Directory
Locations
1840 N Hacienda Blvd
Ste 3
La Puente, CA 91744
Phone (626) 336-5091
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1840 N Hacienda Blvd Ste 3
La Puente, CA 91744-1143
Mailing address
1840 N Hacienda Blvd Ste 3
La Puente, CA 91744-1143
Phone (626) 350-7087
Other providers in La Puente, CA
- Thomas Wan Chong
- David Chou
- Lin Liu Chou
- Citrus Valley Family Medical Clinic, Inc.
- Clinica Medica del Sol Group Inc
- Clinica Medica San Pedro of California Inc
- Brandy Cole
- Rachel Lynn Davis Coleman
- Arelia Conde
- Jasmine Contreras
All providers in La Puente, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.