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

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NPI Details

SU SALUD MEDICAL GROUP INC is a general practice in Huntington Park, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee 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 Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineNo
2207V00000XObstetrics & GynecologyNo
3208000000XPediatricsNo
4207Q00000XFamily MedicineNo
5208D00000XGeneral PracticeYes

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
11922164961MEDICAIDCALIFORNIA

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: 3/30/2025

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