| Edgemont Medical Clinic | |
|
4864 Santa Monica Blvd Los Angeles CA 90029-2634 | |
| (818) 504-7265 | |
| (818) 504-1623 |
| Full Name | Edgemont Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4864 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Antonio Zamorano (PRESIDENT) |
| Authorized Official Contact | 8185047265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgemont Medical Clinic 4864 Santa Monica Blvd Los Angeles CA 90029-2634 Ph: (818) 504-7265 | Edgemont Medical Clinic 4864 Santa Monica Blvd Los Angeles CA 90029-2634 Ph: (818) 504-7265 |
| NPI Number | 1588078166 |
|---|---|
| Provider Enumeration Date | 06/11/2014 |
| Last Update Date | 06/19/2014 |
| Medicare PECOS PAC ID | 7618196650 |
|---|---|
| Medicare Enrollment ID | O20141110000410 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588078166 | NPI | - | NPPES |
| 1043482060 | Other | CA | NPI |
| 1881986826 | Other | CA | NPI 1881986826 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A10630 (California) | Primary |
| 208D00000X | General Practice | 20A10630 (California) | Secondary |
| Provider Name | Arbi Ayvazian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336409291 PECOS PAC ID: 1254553118 Enrollment ID: I20150711000171 |
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