| Fmc 26, Pc | |
|
14547 Victory Blvd Van Nuys CA 91411-1619 | |
| (818) 997-3232 | |
| (818) 997-7750 |
| Full Name | Fmc 26, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14547 Victory Blvd, Van Nuys, California |
| Authorized Official Name and Position | Joabb Marie Grippo (BILLING MANAGER) |
| Authorized Official Contact | 9099675670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fmc 26, Pc 14547 Victory Blvd Van Nuys CA 91411-1619 Ph: (818) 997-3232 | Fmc 26, Pc 14547 Victory Blvd Van Nuys CA 91411-1619 Ph: (818) 997-3232 |
| NPI Number | 1003520065 |
|---|---|
| Provider Enumeration Date | 01/12/2023 |
| Last Update Date | 01/12/2023 |
| Medicare PECOS PAC ID | 0446624381 |
|---|---|
| Medicare Enrollment ID | O20230316001307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003520065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Nouriel Niamehr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679881346 PECOS PAC ID: 6103097274 Enrollment ID: I20110921000307 |
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