Provider Demographics
NPI:1295156982
Name:SAN LUCAS MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:SAN LUCAS MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HINOJOSA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:213-989-1535
Mailing Address - Street 1:13939 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4036
Mailing Address - Country:US
Mailing Address - Phone:213-989-1535
Mailing Address - Fax:888-882-7876
Practice Address - Street 1:13939 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4036
Practice Address - Country:US
Practice Address - Phone:213-989-1535
Practice Address - Fax:888-882-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37463208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAED251AOtherMEDICARE PTAN
CA1396874202Medicaid
CAED251AOtherMEDICARE PTAN
CA1396874202Medicaid