| |
15603 Hawthorne Blvd Suite 103 Lawndale CA 90260-2639 | |
(310) 674-1000 | |
(310) 679-4035 |
Full Name | |
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Speciality | Clinic/center - Medical Specialty |
Location | 15603 Hawthorne Blvd, Lawndale, California |
Authorized Official Name and Position | Jerry A. Okonkwoaguolu (MEDICAL DIRECTOR) |
Authorized Official Contact | 3106741000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 425 Lawndale CA 90260-0425 Ph: (310) 674-1000 | 15603 Hawthorne Blvd Suite 103 Lawndale CA 90260-2639 Ph: (310) 674-1000 |
NPI Number | 1992019590 |
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Provider Enumeration Date | 08/06/2010 |
Last Update Date | 08/12/2016 |
Identifier | Type | State | Issuer |
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1992019590 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | FNP39403 (California) | Secondary |
261QM2500X | Clinic/center - Medical Specialty | FNP39403 (California) | Primary |
Eric A. Enriquez, M.d. Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14623 Hawthorne Blvd, Suite 202, Lawndale, CA 90260 Phone: 310-973-8863 Fax: 310-973-1623 | |
Planned Parenthood Los Angeles, South Bay Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14623 Hawthorne Blvd Ste 300, Lawndale, CA 90260 Phone: 213-284-3121 Fax: 310-219-4040 | |