Corporation Name | |
6907 Seville Ave Hungtington Park CA 90255 | |
(323) 588-1100 | |
(323) 277-0874 |
Full Name | Corporation Name |
---|---|
Speciality | Pediatrics |
Location | 6907 Seville Ave, Hungtington Park, California |
Authorized Official Name and Position | Behrooz Bruce Yagoobian (PRESIDENT) |
Authorized Official Contact | 5626341000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Corporation Name 6907 Seville Ave Hungtington Park CA 90255 Ph: (323) 588-1100 | Corporation Name 6907 Seville Ave Hungtington Park CA 90255 Ph: (323) 588-1100 |
NPI Number | 1619064185 |
---|---|
Provider Enumeration Date | 10/06/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619064185 | NPI | - | NPPES |
GR0080890 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | A48328 (California) | Primary |
208000000X | Pediatrics | A48328 (California) | Primary |