| Loyola Medical Center A Professional Corporation | |
|
4225 Tweedy Blvd South Gate CA 90280-6217 | |
| (323) 564-6464 | |
| (323) 564-8578 |
| Full Name | Loyola Medical Center A Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 4225 Tweedy Blvd, South Gate, California |
| Authorized Official Name and Position | Carlos A Venegas (DIRECTOR) |
| Authorized Official Contact | 3235646464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Loyola Medical Center A Professional Corporation 4225 Tweedy Blvd South Gate CA 90280-6217 Ph: (323) 564-6464 | Loyola Medical Center A Professional Corporation 4225 Tweedy Blvd South Gate CA 90280-6217 Ph: (323) 564-6464 |
| NPI Number | 1467654590 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 02/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467654590 | NPI | - | NPPES |
| 00A393700 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A39370 (California) | Primary |
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