<unavail> in Los Angeles, CA - Medicare Clinic/Center

is a medicare enrolled primary clinic (Clinic/center) in Los Angeles, California. The current practice location for is 11611 San Vicente Blvd, Lobby Level, Los Angeles, California. For appointments, you can reach them via phone at (310) 826-2555. The mailing address for is 11611 San Vicente Blvd, Lobby Level, Los Angeles, California and phone number is (310) 826-2555.

is licensed to practice in California (license number A92794). The clinic also participates in the medicare program and its NPI number is 1194058578. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (310) 826-2555.

Contact Information


	11611 San Vicente Blvd Lobby Level Los Angeles CA 90049-5106
	(310) 826-2555
	(310) 826-2552

Map and Direction

Primary Care Clinic Profile

Full Name
Speciality	Clinic/Center
Location	11611 San Vicente Blvd, Los Angeles, California
Authorized Official Name and Position	Raphael Darvish (PRESIDENT)
Authorized Official Contact	3108262555
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
11611 San Vicente Blvd Lobby Level Los Angeles CA 90049-5106 Ph: (310) 826-2555	11611 San Vicente Blvd Lobby Level Los Angeles CA 90049-5106 Ph: (310) 826-2555

NPI Details:

NPI Number	1194058578
Provider Enumeration Date	09/16/2009
Last Update Date	09/16/2009

Medicare PECOS Information:

Medicare PECOS PAC ID	4981740263
Medicare Enrollment ID	O20090930000603

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1194058578	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
261Q00000X	Clinic/center	A92794 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:

Provider Name	Raphael Darvish
Provider Type	Practitioner - General Practice
Provider Identifiers	NPI Number: 1245457811 PECOS PAC ID: 8628114980 Enrollment ID: I20090930000488

Reviews and Comments

Clinic/Center in Los Angeles, CA

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Altamed Health Services Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5425 Pomona Blvd, Los Angeles, CA 90022 Phone: 323-832-7527 Fax: 323-832-7599
Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 611 S Kingsley Dr, Los Angeles, CA 90005 Phone: 213-201-1623 Fax: 213-201-1595

- Medicare Primary Care in Los Angeles, CA