| Angelus Medical Clinic Multi Specialty Group Inc | |
|
3444 Whittier Blvd Los Angeles CA 90023-1708 | |
| (323) 264-2670 | |
| (213) 377-5738 |
| Full Name | Angelus Medical Clinic Multi Specialty Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3444 Whittier Blvd, Los Angeles, California |
| Authorized Official Name and Position | Nehzat Nikakhtar (PRESIDENT) |
| Authorized Official Contact | 3232642670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angelus Medical Clinic Multi Specialty Group Inc 3444 Whittier Blvd Ste A Los Angeles CA 90023-1708 Ph: (323) 264-2670 | Angelus Medical Clinic Multi Specialty Group Inc 3444 Whittier Blvd Los Angeles CA 90023-1708 Ph: (323) 264-2670 |
| NPI Number | 1447502885 |
|---|---|
| Provider Enumeration Date | 10/09/2012 |
| Last Update Date | 01/25/2022 |
| Medicare PECOS PAC ID | 5496991671 |
|---|---|
| Medicare Enrollment ID | O20130412000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447502885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alan T Turner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659372241 PECOS PAC ID: 9335046994 Enrollment ID: I20031212000868 |
| Provider Name | Divakar Krishnareddy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1871538710 PECOS PAC ID: 1153229109 Enrollment ID: I20031229000624 |
| Provider Name | Marcia Glenn |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1780731976 PECOS PAC ID: 3173595808 Enrollment ID: I20050217000319 |
| Provider Name | Garabed P Nishanian |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1336297290 PECOS PAC ID: 8123074788 Enrollment ID: I20050325000784 |
| Provider Name | Brownell H Payne |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1720156490 PECOS PAC ID: 2365478831 Enrollment ID: I20050715000461 |
| Provider Name | Emmanuel O Emenike |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770570442 PECOS PAC ID: 8224069018 Enrollment ID: I20051018000418 |
| Provider Name | Mohammad R Jaber |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1407980410 PECOS PAC ID: 6507955127 Enrollment ID: I20071205000230 |
| Provider Name | Hugo R Perez |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1669551578 PECOS PAC ID: 3870683402 Enrollment ID: I20071219000352 |
| Provider Name | Duane E Bridges |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154352011 PECOS PAC ID: 3173660032 Enrollment ID: I20091026000231 |
| Provider Name | Harold A Tabaie |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1346286663 PECOS PAC ID: 6507991395 Enrollment ID: I20100318000486 |
| Provider Name | Neil Howard Hecht |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1912902768 PECOS PAC ID: 7315075934 Enrollment ID: I20100503000133 |
| Provider Name | Juan I Sam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033278031 PECOS PAC ID: 0345427449 Enrollment ID: I20110526000402 |
| Provider Name | Nehzat Nikakhtar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427062348 PECOS PAC ID: 1052575107 Enrollment ID: I20120621000269 |
| Provider Name | Tiffany D Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437469269 PECOS PAC ID: 4284863531 Enrollment ID: I20140206001712 |
| Provider Name | Ghassan A Moasis |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1932547122 PECOS PAC ID: 5496996480 Enrollment ID: I20160128002351 |
| Provider Name | Talaat Maximous |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1649274176 PECOS PAC ID: 7618929944 Enrollment ID: I20160419001959 |
| Provider Name | Connie Marie Lapadat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043511900 PECOS PAC ID: 4385872308 Enrollment ID: I20160829003082 |
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