| Aliso Medical Clinic, Inc | |
|
1625 E 4th St Los Angeles CA 90033-4201 | |
| (323) 268-8391 | |
| (323) 268-8014 |
| Full Name | Aliso Medical Clinic, Inc |
|---|---|
| Speciality | General Practice |
| Location | 1625 E 4th St, Los Angeles, California |
| Authorized Official Name and Position | Christine Barnes-keith (ADMINISTRATOR) |
| Authorized Official Contact | 3232688391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aliso Medical Clinic, Inc 1625 E 4th St Los Angeles CA 90033-4201 Ph: (323) 268-8391 | Aliso Medical Clinic, Inc 1625 E 4th St Los Angeles CA 90033-4201 Ph: (323) 268-8391 |
| NPI Number | 1154457745 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154457745 | NPI | - | NPPES |
| ZZZ74805Z | Other | CA | BLUE SHIELD GRP PIN |
| GR0067720 | Medicaid | CA | |
| 00A289340 | Medicaid | CA | |
| 11513273 | Other | CA | CAQH ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A28934 (California) | Primary |
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