| La Community Care Medical Associates Inc | |
|
11633 Hawthorne Blvd Ste 103 Hawthorne CA 90250-2323 | |
| (310) 219-2929 | |
| (310) 219-2940 |
| Full Name | La Community Care Medical Associates Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 11633 Hawthorne Blvd Ste 103, Hawthorne, California |
| Authorized Official Name and Position | Augustine Iluore (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3102192929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Community Care Medical Associates Inc 11633 Hawthorne Blvd Ste 103 Hawthorne CA 90250-2323 Ph: () - | La Community Care Medical Associates Inc 11633 Hawthorne Blvd Ste 103 Hawthorne CA 90250-2323 Ph: (310) 219-2929 |
| NPI Number | 1801099486 |
|---|---|
| Provider Enumeration Date | 06/08/2007 |
| Last Update Date | 04/14/2017 |
| Medicare PECOS PAC ID | 9234303611 |
|---|---|
| Medicare Enrollment ID | O20111121000755 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801099486 | NPI | - | NPPES |
| GR0081270 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A053317 (California) | Primary |
| 207R00000X | Internal Medicine | A053317 (California) | Secondary |
| Provider Name | Augustine E Iluore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336205442 PECOS PAC ID: 8426222803 Enrollment ID: I20111121000739 |
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