Provider Demographics
NPI:1023469616
Name:SAMARITANA MEDICAL CLINIC EAST LA INC
Entity type:Organization
Organization Name:SAMARITANA MEDICAL CLINIC EAST LA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:323-725-1144
Mailing Address - Street 1:6007 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4401
Mailing Address - Country:US
Mailing Address - Phone:323-725-1144
Mailing Address - Fax:
Practice Address - Street 1:6007 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4401
Practice Address - Country:US
Practice Address - Phone:323-725-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITANA MEDICAL CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-25
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty