| Deorosan Professional Medical Corporation | |
|
11502 S Vermont Ave Los Angeles CA 90044-6522 | |
| (323) 779-2800 | |
| (323) 754-4014 |
| Full Name | Deorosan Professional Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 11502 S Vermont Ave, Los Angeles, California |
| Authorized Official Name and Position | Verretta Deorosan (PRESIDENT/OWNER) |
| Authorized Official Contact | 3237792800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deorosan Professional Medical Corporation 11502 S Vermont Ave Los Angeles CA 90044-6522 Ph: (323) 779-2800 | Deorosan Professional Medical Corporation 11502 S Vermont Ave Los Angeles CA 90044-6522 Ph: (323) 779-2800 |
| NPI Number | 1497939177 |
|---|---|
| Provider Enumeration Date | 12/18/2007 |
| Last Update Date | 12/18/2007 |
| Medicare PECOS PAC ID | 8729158027 |
|---|---|
| Medicare Enrollment ID | O20080529000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497939177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G73639 (California) | Primary |
| Provider Name | Veretta Deorosan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104997683 PECOS PAC ID: 0648340935 Enrollment ID: I20080529000242 |
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