Full Name | |
---|---|
Speciality | General Practice |
Location | 640 Main St, Venice, California |
Authorized Official Name and Position | Stuart Clark (EXECUTIVE VP) |
Authorized Official Contact | 7037600700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
5500 Maryland Way Ste 400 Brentwood TN 37027-4948 Ph: () - | 640 Main St Venice CA 90291-2524 Ph: (650) 214-6369 |
NPI Number | 1609151638 |
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Provider Enumeration Date | 10/21/2011 |
Last Update Date | 08/16/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609151638 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Venice Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 622 Rose Ave, Venice, CA 90291 Phone: 310-392-8636 | |