Clinica Medica San Marcos, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

0711339 Issued in CA

Legal business name

CLINICA MEDICA SAN MARCOS, INC

Practice address

3221 Liberty Blvd
South Gate, CA 90280-2315

Phone

(323) 566-9171

Fax

(323) 566-9178

NPI assigned

Jan 28, 2008

Last updated

Jan 10, 2013By 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

Gustavo T. Roldan, PA-C

Title

Manager

Phone

(323) 566-9171

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1649457037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 LIBERTY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802315",
            "telephone_number": "323-566-9171",
            "fax_number": "323-566-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 LIBERTY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802315",
            "telephone_number": "323-566-9171",
            "fax_number": "323-566-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MEDICA SAN MARCOS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "ROLDAN",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "323-566-9171",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "0711339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eumi Choi, DDS
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• John Chung, DC
• Josefina Clark, CNM
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• Clinica Medica San Pedro of California Inc
• Clinica San Marcos Medical Center Apc
• Cohen & Keihani & Jabaiti Dental Corp (Simple Dental Southgate)
• Kenneth Cohn, M.D.
• Brenda Del Pilar Collao, MA, AMFT

• Primary Care Clinic/Center in South Gate, CA
• Providers in South Gate, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.