Provider Demographics
NPI:1386357697
Name:S & J MEDICAL CLINIC INC
Entity type:Organization
Organization Name:S & J MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:323-406-2204
Mailing Address - Street 1:3710 E CESAR E CHAVEZ AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2219
Mailing Address - Country:US
Mailing Address - Phone:323-406-2204
Mailing Address - Fax:323-406-2327
Practice Address - Street 1:3710 E CESAR E CHAVEZ AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2219
Practice Address - Country:US
Practice Address - Phone:323-406-2204
Practice Address - Fax:323-406-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty