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1907 Border Ave Torrance CA 90501-3606 | |
| (844) 443-6246 | |
| (833) 907-2235 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1907 Border Ave, Torrance, California |
| Authorized Official Name and Position | Robert Mbonye (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 5852780502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
35 W 35th St Fl 6 New York NY 10001-2205 Ph: (844) 553-6246 | 1907 Border Ave Torrance CA 90501-3606 Ph: (844) 443-6246 |
| NPI Number | 1710690433 |
|---|---|
| Provider Enumeration Date | 12/27/2022 |
| Last Update Date | 01/06/2025 |
| Medicare PECOS PAC ID | 9739544206 |
|---|---|
| Medicare Enrollment ID | O20230505001326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710690433 | NPI | - | NPPES |
| Provider Name | Carlos Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992724538 PECOS PAC ID: 1254362379 Enrollment ID: I20230505001440 |
| Provider Name | Matia Lavonne Kilgore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730775958 PECOS PAC ID: 0547659146 Enrollment ID: I20241118001639 |
| Provider Name | Heather Nicole Boring Fedor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376959726 PECOS PAC ID: 1456571967 Enrollment ID: I20241206001590 |
| Provider Name | Karyn Maria Guido |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497294177 PECOS PAC ID: 8325448129 Enrollment ID: I20241210003423 |
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