Los Reyes Medical Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A41152 Issued in CA

Legal business name

LOS REYES MEDICAL CLINIC, INC

Doing business as

LOS HERMANOS MEDICAL CLINIC

Practice address

2715 Santa Ana St
South Gate, CA 90280-2021

Phone

(323) 583-0450

Fax

(323) 583-0019

NPI assigned

Oct 31, 2006

Organization subpart

No

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

Authorized official

Name

Windgrove David Daniel, M.D.

Title

Medical Director/ President

Phone

(323) 583-0450

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LOS HERMANOS MEDICAL CLINIC Doing business as

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730265828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 SANTA ANA ST",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802021",
            "telephone_number": "323-583-0450",
            "fax_number": "323-583-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 SANTA ANA ST",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802021",
            "telephone_number": "323-583-0450",
            "fax_number": "323-583-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS REYES MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "WINDGROVE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/ PRESIDENT",
        "authorized_official_telephone_number": "323-583-0450",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A41152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MEDI-CAL",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOS HERMANOS MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in South Gate, CA
• Providers in South Gate, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.