NPIMap

Organization Active NPI

Clinica Monsignor Oscar a Romero

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1316033533
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960001398 Issued in CA
Legal business name
CLINICA MONSIGNOR OSCAR A ROMERO
Practice address
2032 Marengo Street
Los Angeles, CA 90033-1319
Phone
(213) 989-7700
Fax
(323) 221-4528
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960001398 CA Primary

Addresses

Primary practice location

2032 Marengo Street
Los Angeles, CA 90033-1319

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC71005FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050810001030 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264490218 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 051023

Legal name
CLINICA MONSIGNOR OSCAR A. ROMERO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 13, 2005
Last certification
Sep 13, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1983 in CA
Enrollment address
2032 Marengo St
Los Angeles, CA 90033-1319

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Carlos Hernandez Vaquerano Individual Corporate OfficerChief Executive Officer Jan 1, 2019
Corporate DirectorChief Executive Officer Jan 1, 2019
W-2 Managing Employee Jan 1, 2019
Operational/Managerial Control Jan 1, 2019

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": "1470960000000",
    "number": "1316033533",
    "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": "213-989-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2032 MARENGO STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331319",
            "telephone_number": "213-989-7700",
            "fax_number": "323-221-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MONSIGNOR OSCAR A ROMERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2016-08-12",
        "status": "A",
        "authorized_official_last_name": "ROSATTO",
        "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": "960001398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71005F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.