NPIMap

Organization Active NPI

Los Angeles Clinica Medica General Medical Center, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1265489751
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.
Practice address
2208 W 7TH St
Los Angeles, CA 90057-4002
Phone
(213) 384-3434
Fax
(213) 386-2039
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

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

Authorized official

Name
Mr. Jose Luis Carrillo Jr.
Title
Business Accounts Manager
Phone
(213) 739-3282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2208 W 7TH St
Los Angeles, CA 90057-4002

Mailing address

PO Box 10432
Beverly Hills, CA 90213-3432
Phone (213) 637-2530

Other identifiers 1

IdentifierTypeStateIssuer
GR0076110MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408000670 CA Part B Supplier - Clinic/Group Practice 1254324742 Receives reassigned benefits from 32 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596153600000",
    "number": "1265489751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10432",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902133432",
            "telephone_number": "213-637-2530",
            "fax_number": "231-384-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 W 7TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574002",
            "telephone_number": "213-384-3434",
            "fax_number": "213-386-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "BUSINESS ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "213-739-3282",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0076110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.