| Angeles Comprehensive Community Clinic, Inc. | |
|
3920 Eagle Rock Blvd. Suite A Los Angeles CA 90065-3606 | |
| (323) 255-5225 | |
| (323) 255-5229 |
| Full Name | Angeles Comprehensive Community Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3920 Eagle Rock Blvd., Los Angeles, California |
| Authorized Official Name and Position | Liana Kazarova (ADMINISTRATOR) |
| Authorized Official Contact | 3232555225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angeles Comprehensive Community Clinic, Inc. 3920 Eagle Rock Blvd. Suite A Los Angeles CA 90065-3606 Ph: (323) 255-5225 | Angeles Comprehensive Community Clinic, Inc. 3920 Eagle Rock Blvd. Suite A Los Angeles CA 90065-3606 Ph: (323) 255-5225 |
| NPI Number | 1457470684 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 08/26/2014 |
| Medicare PECOS PAC ID | 9436259553 |
|---|---|
| Medicare Enrollment ID | O20080709000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457470684 | NPI | - | NPPES |
| OXG182 | Other | CA | BLUE CROSS |
| ZZZ552884 | Other | CA | BLUE SHIELD |
| 1326349960 | Other | CA | NPI |
| 91355 | Other | CA | HEALTHY FAMILY ENROLLMENT ENTITY |
| CB217375 | Other | CA | MEDICARE PTAN |
| 1457470684 | Medicaid | CA | |
| G56432MM2 | Other | CA | LA CARE |
| 1427355981 | Other | CA | NPI |
| 8370190013 | Other | CA | CIGNA |
| 1811043474 | Other | CA | NPI |
| OO3991 | Other | CA | HEALTH NET |
| 1427003300 | Other | CA | NPI |
| G56432F11 | Other | CA | CARE 1ST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 550000708 (California) | Primary |
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