Provider Demographics
NPI:1154887560
Name:SAMARITANA MEDICAL CLINIC,INC.
Entity type:Organization
Organization Name:SAMARITANA MEDICAL CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-483-3600
Mailing Address - Street 1:2661 E FLORENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4793
Mailing Address - Country:US
Mailing Address - Phone:323-583-3375
Mailing Address - Fax:877-340-3470
Practice Address - Street 1:4149 TWEEDY BLVD STE B
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6167
Practice Address - Country:US
Practice Address - Phone:323-825-0180
Practice Address - Fax:877-340-3470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty