Clinica Medica San Marcos Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

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

Jul 24, 2007

Organization subpart

No

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

Authorized official

Name

Gustavo Roldan, PAC

Title

Secretary

Phone

(323) 566-9171

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1679773840",
    "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": "2007-07-24",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "ROLDAN",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "323-566-9171",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in South Gate, CA
• Providers in South Gate, CA by specialty
• General Practice Physician 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.