Provider Demographics
NPI:1902355647
Name:EAST LA PAZ FAMILY MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:EAST LA PAZ FAMILY MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:323-268-8347
Mailing Address - Street 1:3712 WHITTIER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1733
Mailing Address - Country:US
Mailing Address - Phone:323-268-8347
Mailing Address - Fax:323-268-8368
Practice Address - Street 1:3712 WHITTIER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1733
Practice Address - Country:US
Practice Address - Phone:323-268-8347
Practice Address - Fax:323-268-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy