| Ch Specialty Services Ca Pc | |
|
3415 S Sepulveda Blvd Ste 1100 Los Angeles CA 90034-7090 | |
| (337) 991-9276 | |
| Not Available |
| Full Name | Ch Specialty Services Ca Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3415 S Sepulveda Blvd Ste 1100, Los Angeles, California |
| Authorized Official Name and Position | Nicole Howard (SR VP OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 3379919276 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ch Specialty Services Ca Pc 1509 Dulles Dr Lafayette LA 70506-3718 Ph: (337) 991-9276 | Ch Specialty Services Ca Pc 3415 S Sepulveda Blvd Ste 1100 Los Angeles CA 90034-7090 Ph: (337) 991-9276 |
| NPI Number | 1730888041 |
|---|---|
| Provider Enumeration Date | 02/24/2023 |
| Last Update Date | 02/24/2023 |
| Medicare PECOS PAC ID | 8820462203 |
|---|---|
| Medicare Enrollment ID | O20230327001060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730888041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark Daryl Canty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962573626 PECOS PAC ID: 0840180113 Enrollment ID: I20040318001601 |
| Provider Name | Jayson Alan Weir |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1518257138 PECOS PAC ID: 2163647355 Enrollment ID: I20140701002282 |
| Provider Name | Tina Shenouda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326386996 PECOS PAC ID: 9537397872 Enrollment ID: I20230404000647 |
| Provider Name | Brian Cooper |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366678963 PECOS PAC ID: 0547426223 Enrollment ID: I20230502001105 |
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