| Angeles Medical Clinic, Inc. | |
|
204 E Pico Blvd Los Angeles CA 90015-2508 | |
| (213) 457-4000 | |
| (213) 457-6000 |
| Full Name | Angeles Medical Clinic, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 204 E Pico Blvd, Los Angeles, California |
| Authorized Official Name and Position | Sarvenaz Saadat Mobasser (PRESIDENT) |
| Authorized Official Contact | 2134574000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angeles Medical Clinic, Inc. Po Box 299 Beverly Hills CA 90213-0299 Ph: (213) 457-4000 | Angeles Medical Clinic, Inc. 204 E Pico Blvd Los Angeles CA 90015-2508 Ph: (213) 457-4000 |
| NPI Number | 1528344686 |
|---|---|
| Provider Enumeration Date | 11/02/2011 |
| Last Update Date | 09/11/2012 |
| Medicare PECOS PAC ID | 2163681495 |
|---|---|
| Medicare Enrollment ID | O20120306000888 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528344686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A104717 (California) | Primary |
| Provider Name | Sarvenaz Saadat Mobasser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295061786 PECOS PAC ID: 6800046913 Enrollment ID: I20121026000336 |
| Provider Name | Marilyn Mennig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043222458 PECOS PAC ID: 2668715673 Enrollment ID: I20190514003277 |
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