Provider Demographics
NPI:1447593868
Name:DE LA PAZ MEDICAL CENTRE INC
Entity type:Organization
Organization Name:DE LA PAZ MEDICAL CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRYA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:714-356-0999
Mailing Address - Street 1:934 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1523
Mailing Address - Country:US
Mailing Address - Phone:714-254-0224
Mailing Address - Fax:714-254-0234
Practice Address - Street 1:934 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802
Practice Address - Country:US
Practice Address - Phone:714-254-0224
Practice Address - Fax:714-254-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447593868Medicaid