SAN PEDRO MEDICAL CLINIC (NPI# 1952624140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952624140 |
| Entity Type | Organization |
| Organization Name | SAN PEDRO MEDICAL CLINIC |
| Practice Address |
715 S Averill Ave San Pedro CA 90732-3813 |
| Practice Telephone | 3108319080 |
| Practice Fax Number | 3108319081 |
| Mailing Telephone | 3108319080 |
| Mailing Fax Number | 3108319081 |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-03-02 |
| Authorized Official Name | KRISTINA KUTSINA (MANAGER) |
| Authorized Official Telephone | 3108319080 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
715 S AVERILL AVE |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90732-3813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528148897 | Nicol Lippman, Md, Inc. | Internal Medicine | 715 S Averill Ave, San Pedro, CA 90732-3813 | 2006-10-17 |
| 1154876852 | Gs Medical Center Inc | Non-Pharmacy Dispensing Site | 715 S Averill Ave, San Pedro, CA 90732-3813 | 2016-08-23 |
| 1760835086 | Dr. Gregory A. Smith, Md Inc. | Family Medicine | 715 S Averill Ave, San Pedro, CA 90732-3813 | 2016-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771241 | Alicia Avila | Student in an Organized Health Care Education/Training Program | 2227 Blue Butterfly Way, #7, San Pedro, CA 90732 | 2020-08-24 |
| 1619500543 | Udana Harris | Registered Nurse | 1300 West 7th Street, Obhc Unit, San Pedro, CA 90732 | 2020-02-19 |
| 1861042301 | Patricia Elaine Moses | Technician | 106 N. Western Ave Unit 102, San Pedro, CA 90732 | 2019-09-17 |
| 1629627393 | Antonio Ramon Martinez | Technician | 3141 Blue Butterfly Unit 66, San Pedro, CA 90732 | 2019-09-05 |
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144566563 | Shaun E Chandran M D Inc | Orthopaedic Surgery | 1360 W 6th Street, Suite 305, San Pedro, CA 90732 | 2012-12-13 |
| 1316281280 | Jenny Luong | Physician Assistant | 1534 W. 25th St, San Pedro, CA 90732 | 2012-11-16 |
| 1033429519 | Eric M Feit Dpm Inc | Podiatrist | 1360 West 6th St., Suite 240, San Pedro, CA 90732 | 2010-10-18 |
| 1386808673 | Meysam Zaker | Dentist | 2470 S. Western Ave, San Pedro, Ca, CA 90732 | 2008-07-15 |
| 1376735340 | Francisco J. Correa, M.d., Inc | General Practice | 1350 W. 6th St, #3, San Pedro, CA 90732 | 2007-08-14 |
| Find all providers in zip 90732 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649878117 | Cameron S Francis Md Inc | Clinic/Center | 1431 Camino Del Mar, Del Mar, CA 92014-2509 | 2020-10-15 |
| 1982211835 | Crossover Health Medical Group | Clinic/Center | 711 W 2nd St Ste A, San Bernardino, CA 92410-3262 | 2020-09-24 |
| 1982211843 | Crossover Health Medical Group | Clinic/Center | 5379 Hamner Ave Unit 801, Eastvale, CA 91752-1042 | 2020-09-24 |
| 1164039020 | Crossover Health Medical Group | Clinic/Center | 14329 Frederick St Ste 7-9, Moreno Valley, CA 92553-9003 | 2020-09-24 |
| 1104432673 | Aleracare Medical Group of California | Clinic/Center | 17777 Ventura Blvd Ste 220, Encino, CA 91316-3748 | 2020-09-21 |
| 1205447687 | Shawn Richard Oneill | Clinic/Center | 5979 Trotters Ln, Alta Loma, CA 91701-2644 | 2020-08-11 |
| 1134738032 | Healthworks Med Group of California A Medical Corporation | Clinic/Center | 2821 Scott Blvd Ste 2126, Santa Clara, CA 95050-2549 | 2020-07-27 |
| 1437767951 | Miro Health | Clinic/Center | 260 King St Unit 1505, San Francisco, CA 94107-6415 | 2020-07-21 |
| 1598383895 | Alacrity Patient Services, Inc. | Clinic/Center | 1002 N Hudson Ave Apt 1, Los Angeles, CA 90038-2595 | 2020-07-13 |
| 1306464979 | Aleracare Medical Group of California | Clinic/Center | 4849 Van Nuys Blvd Ste 220, Sherman Oaks, CA 91403-2155 | 2020-07-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.