| Eagle Rock Medical Center | |
|
4867 Eagle Rock Blvd Ste 1 Los Angeles CA 90041-2649 | |
| (323) 254-6754 | |
| (323) 257-5949 |
| Full Name | Eagle Rock Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 4867 Eagle Rock Blvd Ste 1, Los Angeles, California |
| Authorized Official Name and Position | Ayuna Panossian (OWNER) |
| Authorized Official Contact | 3232546754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Rock Medical Center 4867 Eagle Rock Blvd Ste 1 Los Angeles CA 90041-2649 Ph: (323) 254-6754 | Eagle Rock Medical Center 4867 Eagle Rock Blvd Ste 1 Los Angeles CA 90041-2649 Ph: (323) 254-6754 |
| NPI Number | 1972283760 |
|---|---|
| Provider Enumeration Date | 07/18/2023 |
| Last Update Date | 07/25/2023 |
| Medicare PECOS PAC ID | 7810350410 |
|---|---|
| Medicare Enrollment ID | O20230830001403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972283760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ayuna K Panossian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952423014 PECOS PAC ID: 0547367732 Enrollment ID: I20070523000287 |
| Provider Name | Raymond J Dorio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205984739 PECOS PAC ID: 4284705138 Enrollment ID: I20080619000534 |
| Provider Name | Mercy Ragas Florida |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134749286 PECOS PAC ID: 4082036819 Enrollment ID: I20200623003082 |
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