SU SALUD MEDICAL GROUP INC NPI 1104476217

NPI Information

NPI: 1104476217
Provider Name: SU SALUD MEDICAL GROUP INC
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 05D2172755

Address:
7418 STATE ST
HUNTINGTON PARK, CA
ZIP 90255
Phone: (323) 835-6298
Get Directions

SU SALUD MEDICAL GROUP INC is a general practice in Huntington Park, CA. SU SALUD MEDICAL GROUP INC NPI is 1104476217. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7418 STATE ST
HUNTINGTON PARK, CA
ZIP 90255-928
Phone: (323) 835-6298
Fax: (323) 835-6081

The provider's authorized official is Abdel N Abdelsayed .
The authorized official title is Medical Director and has the following contact phone number (323) 918-2700.

The CLIA number assigned to this NPI record is 05D2172755 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/19/2019 and was last updated on 5/1/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	207R00000X	Internal Medicine	No
2	207V00000X	Obstetrics & Gynecology	No
3	208000000X	Pediatrics	No
4	207Q00000X	Family Medicine	No
5	208D00000X	General Practice	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1922164961	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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