| Mensa Family Clinic Inc | |
|
1110 S Glendale Ave Ste E Glendale CA 91205-5623 | |
| (818) 945-5502 | |
| (818) 945-5595 |
| Full Name | Mensa Family Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1110 S Glendale Ave Ste E, Glendale, California |
| Authorized Official Name and Position | Svetlana Viktorovna Gorelikova (PRESIDENT) |
| Authorized Official Contact | 8189455502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mensa Family Clinic Inc 1110 S Glendale Ave Ste E Glendale CA 91205-5623 Ph: (818) 945-5502 | Mensa Family Clinic Inc 1110 S Glendale Ave Ste E Glendale CA 91205-5623 Ph: (818) 945-5502 |
| NPI Number | 1871050559 |
|---|---|
| Provider Enumeration Date | 02/28/2019 |
| Last Update Date | 02/28/2019 |
| Medicare PECOS PAC ID | 5092056952 |
|---|---|
| Medicare Enrollment ID | O20190403001536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871050559 | NPI | - | NPPES |
| A102339 | Other | CA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Svetlana V Gorelikova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699953604 PECOS PAC ID: 3870644545 Enrollment ID: I20090619000575 |
| Provider Name | Bernadette D Guia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376911131 PECOS PAC ID: 4486678406 Enrollment ID: I20180530003068 |
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