NPIMap

Organization Active NPI

Clinica Monsignor Oscar a Romero

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1275629495
Registry record updated Aug 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000308 Issued in CA
Legal business name
CLINICA MONSIGNOR OSCAR A ROMERO
Practice address
123 S Alvarado Street
Los Angeles, CA 90057-2201
Phone
(213) 989-7700
Fax
(213) 989-7702
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2016

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

Authorized official

Name
Sandra Rossato
Title
Executive Director
Phone
(213) 201-2737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960000308 CA Primary

Addresses

Primary practice location

123 S Alvarado Street
Los Angeles, CA 90057-2201

Mailing address

123 S Alvarado Street
Los Angeles, CA 90057-2201
Phone (213) 989-7700

Other identifiers 1

IdentifierTypeStateIssuer
FHC70567FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041222000566 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264490218 Practice locations: Los Angeles, CA
O20230815003521 CA Part B Supplier - Clinic/Group Practice 2264490218 Receives reassigned benefits from 23 practitioners
Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275629495. Details of each certification follow.

Federally qualified health center certification: CCN 051007

Legal name
CLINICA MONSIGNOR OSCAR A. ROMERO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 27, 2005
Last certification
Apr 27, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1983 in CA
Enrollment address
123 S Alvarado St
Los Angeles, CA 90057-2201

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

Locations

21013 Sherman Way
Canoga Park, CA 91303

2032 Marengo St
Los Angeles, CA 90033
Phone (213) 989-7700

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Sandra B Rossato Individual Corporate Officer Mar 1, 2022
W-2 Managing EmployeeChief of Staff Mar 1, 2022
Carlos Hernandez Vaquerano Individual Corporate OfficerChief Executive Officer Jul 1, 2018
W-2 Managing EmployeeChief Executive Officer Jul 1, 2018

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1275629495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S ALVARADO STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572201",
            "telephone_number": "213-989-7700",
            "fax_number": "213-989-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S ALVARADO STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572201",
            "telephone_number": "213-989-7700",
            "fax_number": "213-989-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MONSIGNOR OSCAR A ROMERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "ROSSATO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "213-201-2737"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70567F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.