La Providencia Medical Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LA PROVIDENCIA MEDICAL CLINIC

Practice address

3412 Whittier Blvd
Los Angeles, CA 90023

Phone

(323) 264-4006

Fax

(323) 264-4052

NPI assigned

Sep 14, 2007

Last updated

Sep 14, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Samuel Wosk, MDNPI 1689604951

Title

Director

Phone

(323) 264-4006

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Samuel R Wosk, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1689604951
  NPD (past) Authorized official

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

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189728000000",
    "number": "1609061431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90023",
            "telephone_number": "323-264-4006",
            "fax_number": "323-264-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90023",
            "telephone_number": "323-264-4006",
            "fax_number": "323-264-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PROVIDENCIA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2007-09-14",
        "status": "A",
        "authorized_official_last_name": "WOSK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "323-264-4006",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lisa Winters La Rose, LCSW

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.