| Good Neighbor Clinic Crenshaw Boulevard | |
|
4300 Crenshaw Blvd. Los Angeles CA 90008 | |
| (323) 298-1668 | |
| (323) 298-0458 |
| Full Name | Good Neighbor Clinic Crenshaw Boulevard |
|---|---|
| Speciality | Clinic/Center |
| Location | 4300 Crenshaw Blvd., Los Angeles, California |
| Authorized Official Name and Position | Daniel Shane Sheibani Davidson (ADMINISTRATOR) |
| Authorized Official Contact | 3102121500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Neighbor Clinic Crenshaw Boulevard 1270 S Alfred St Unit 1064 Los Angeles CA 90035-2506 Ph: (310) 212-1500 | Good Neighbor Clinic Crenshaw Boulevard 4300 Crenshaw Blvd. Los Angeles CA 90008 Ph: (323) 298-1668 |
| NPI Number | 1689073595 |
|---|---|
| Provider Enumeration Date | 08/15/2014 |
| Last Update Date | 05/24/2024 |
| Certification Date | 05/24/2024 |
| Medicare PECOS PAC ID | 0941427264 |
|---|---|
| Medicare Enrollment ID | O20140811001591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689073595 | NPI | - | NPPES |
| Provider Name | Brian K Gamble |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1568478436 PECOS PAC ID: 3971597121 Enrollment ID: I20040413000774 |
| Provider Name | Hazel Mckillop |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396766994 PECOS PAC ID: 5294799201 Enrollment ID: I20050413000510 |
| Provider Name | Franklin D Westhout |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1659605475 PECOS PAC ID: 2668596230 Enrollment ID: I20100902001121 |
| Provider Name | Amos K Ladouceur |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033413265 PECOS PAC ID: 1759674641 Enrollment ID: I20160729002070 |
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