Santa Rosa de Lima Medical Clinic Inc.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A53394 Issued in CA

Legal business name

SANTA ROSA DE LIMA MEDICAL CLINIC INC.

Practice address

6915 Seville Ave
Huntington Park, CA 90255-4901

Phone

(323) 588-9800

NPI assigned

Feb 9, 2007

Organization subpart

No

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

Authorized official

Name

Edwin ZevallosNPI 1518042498

Title

Physycian

Phone

(323) 588-9800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edwin Werner Zevallos, M.D.

  • Internal Medicine Physician
  • Huntington Park, CA
  • NPI 1518042498
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821139205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6915 SEVILLE AVENUE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "90255",
            "telephone_number": "323-588-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6915 SEVILLE AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554901",
            "telephone_number": "323-588-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA DE LIMA MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZEVALLOS",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "PHYSYCIAN",
        "authorized_official_telephone_number": "323-588-9800"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A53394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delvon Sanders
• Tina Sandoval
• Viridiana Sandoval, PPS
• Charles Sangmoah
• Fidel Santa Cruz, MD
• Emmanuel Santana, LCSW 79744
• Claudia Raquel Santis, NURSE PRACTITIONER
• Edna Sarino, NP, FNP-C
• Rebecca Scaiffe
• Tonya Alenna Schofield

• General Practice Physician in Huntington Park, CA
• Providers in Huntington Park, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.