NPIMap

Organization Active NPI

Clinica Monsignor Oscar a Romero

  • Federally Qualified Health Center (FQHC)
  • Montebello, CA
National Provider Identifier
1295483204
Registry record updated Mar 17, 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
540 N Montebello Blvd Ste D
Montebello, CA 90640-3662
Phone
(323) 728-0080
Fax
(323) 728-0090
NPI assigned
Mar 17, 2022
Last updated
Mar 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2022

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

Authorized official

Name
Sandra Rossato
Title
Authorized Official
Phone
(213) 201-2737

Specialties & licenses 1

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

Addresses

Primary practice location

540 N Montebello Blvd Ste D
Montebello, CA 90640-3662

Mailing address

540 N Montebello Blvd Ste D
Montebello, CA 90640-3662
Phone (323) 728-0080

Other identifiers 1

IdentifierTypeStateIssuer
1275629495MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL epic Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250304003580 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264490218 Practice locations: Montebello, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295483204. Details of each certification follow.

Federally qualified health center certification: CCN A01929

Legal name
CLINICA MONSIGNOR OSCAR A. ROMERO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 27, 2025
Last certification
Feb 27, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
540 N Montebello Blvd
Ste D
Montebello, CA 90640-3662

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 Rom12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

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

540 N Montebello Blvd
Montebello, CA 90640

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 DirectorMember, Board of Directors Jan 1, 2022
Armando Carranza Individual Corporate DirectorSecretary of the Board of Directors Jan 1, 2022
Jose Hernandez Individual Corporate DirectorTreasurer of the Board of Directors Jan 1, 2022
Jose Ruiz Individual Corporate DirectorMember, Board of Directors Jan 1, 2022
Mario Hercules Individual Corporate DirectorMember, Board of Directors Jan 1, 2022
Sandra Gonzalez Individual Corporate DirectorMember, Board of Directors Jan 1, 2022
Santos Fernandez Individual Corporate DirectorMember, Board of Director Jan 1, 2022
Lizeth Chicas Individual Corporate DirectorMember, Board of Directors Jan 1, 2020
Sonia Molina Individual Corporate DirectorPresident of the Board of Directors Jan 1, 2022
Carlos Hernandez Vaquerano Individual Corporate OfficerCeo Oct 1, 2018 100%
W-2 Managing EmployeeAd; Oct 1, 2018 100%

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1295483204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 N MONTEBELLO BLVD STE D",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403662",
            "telephone_number": "323-728-0080",
            "fax_number": "323-728-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 N MONTEBELLO BLVD STE D",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403662",
            "telephone_number": "323-728-0080",
            "fax_number": "323-728-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MONSIGNOR OSCAR A ROMERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "ROSSATO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "213-201-2737"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275629495",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "epic",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "540 N Montebello Blvd Ste D",
            "city": "Montebello",
            "state": "CA",
            "country_code": "US",
            "postal_code": "906403662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

Verify at the official NPI Registry.