| Mission City Community Network, Inc. | |
|
4842 Hollywood Blvd Hollywood CA 90027-5302 | |
| (323) 644-1110 | |
| (323) 644-1171 |
| Full Name | Mission City Community Network, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4842 Hollywood Blvd, Hollywood, California |
| Authorized Official Name and Position | Nik Gupta (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8188953100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission City Community Network, Inc. 15206 Parthenia St North Hills CA 91343-5305 Ph: (818) 895-3100 | Mission City Community Network, Inc. 4842 Hollywood Blvd Hollywood CA 90027-5302 Ph: (323) 644-1110 |
| NPI Number | 1710102009 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 03/21/2011 |
| Medicare PECOS PAC ID | 1658264684 |
|---|---|
| Medicare Enrollment ID | O20040204000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710102009 | NPI | - | NPPES |
| FHC70938F | Other | CA | MEDICAL PROVIDER NUMBER |
| HAP70436F | Medicaid | CA | |
| 551067 | Other | CA | MEDICARE FQHC |
| Provider Name | Arakel Davtian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275584260 PECOS PAC ID: 5991786287 Enrollment ID: I20040524001441 |
| Provider Name | Saeed Eskandari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902092042 PECOS PAC ID: 2668443649 Enrollment ID: I20040803001494 |
| Provider Name | Hitesh C Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902833734 PECOS PAC ID: 3577537075 Enrollment ID: I20040820000988 |
| Provider Name | Travis D Fultz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831171388 PECOS PAC ID: 4486621596 Enrollment ID: I20040916000550 |
| Provider Name | Shewak R Lund |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1336244458 PECOS PAC ID: 9739148644 Enrollment ID: I20041006001202 |
| Provider Name | Annette Kroes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184750341 PECOS PAC ID: 2163484791 Enrollment ID: I20041027000372 |
| Provider Name | Alan Markie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861475337 PECOS PAC ID: 8123086857 Enrollment ID: I20041228000990 |
| Provider Name | Roselyn M Dinsay |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861464612 PECOS PAC ID: 7618924028 Enrollment ID: I20050406001205 |
| Provider Name | Steven C Reiner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578547576 PECOS PAC ID: 9032154174 Enrollment ID: I20050620001163 |
| Provider Name | Sanjay M Vaswani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982752952 PECOS PAC ID: 2163459991 Enrollment ID: I20050722000428 |
| Provider Name | Mehboob A Makhani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386610988 PECOS PAC ID: 3375575962 Enrollment ID: I20050902000615 |
| Provider Name | Humberto Gutierrez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881784049 PECOS PAC ID: 5698793578 Enrollment ID: I20051109000592 |
| Provider Name | Edmund Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497836670 PECOS PAC ID: 2769492917 Enrollment ID: I20060502000693 |
| Provider Name | Jun R Chiong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598730590 PECOS PAC ID: 5890740773 Enrollment ID: I20060727000110 |
| Provider Name | Frederick Chu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619950748 PECOS PAC ID: 4880692995 Enrollment ID: I20061129000265 |
| Provider Name | Terry L Chase |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447234679 PECOS PAC ID: 9436157542 Enrollment ID: I20061129000273 |
| Provider Name | Alete S Arom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225121981 PECOS PAC ID: 2769588375 Enrollment ID: I20070427000349 |
| Provider Name | Caroline O Egekeze |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407873102 PECOS PAC ID: 0042393985 Enrollment ID: I20080214000600 |
| Provider Name | John H Rastegar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609936483 PECOS PAC ID: 2163583964 Enrollment ID: I20081211000853 |
| Provider Name | Joshua K Koh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871609271 PECOS PAC ID: 6901968288 Enrollment ID: I20081219000525 |
| Provider Name | Tatyana A Kushnirenko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992989305 PECOS PAC ID: 9830251776 Enrollment ID: I20081230000626 |
| Provider Name | Tshekedi Galen Dennis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215015508 PECOS PAC ID: 9830254432 Enrollment ID: I20090216000052 |
| Provider Name | Sarabjit Singh Sandhu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144287186 PECOS PAC ID: 7517959075 Enrollment ID: I20090707000610 |
| Provider Name | John P Chard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881706026 PECOS PAC ID: 3072669043 Enrollment ID: I20090916000010 |
| Provider Name | Ronald G Huston |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215193198 PECOS PAC ID: 6800936139 Enrollment ID: I20091217000645 |
| Provider Name | Mahamaya A Shenoy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1861536591 PECOS PAC ID: 2668505231 Enrollment ID: I20100803000596 |
| Provider Name | Jennifer Lim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528288990 PECOS PAC ID: 5698809416 Enrollment ID: I20100816000947 |
| Provider Name | Iraj Shamsa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1871655654 PECOS PAC ID: 2466648399 Enrollment ID: I20101118000126 |
| Provider Name | Burn Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912196056 PECOS PAC ID: 6002004900 Enrollment ID: I20101220000257 |
| Provider Name | Vinod Sodha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134375223 PECOS PAC ID: 3779763065 Enrollment ID: I20110203000291 |
| Provider Name | Anthony Shin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982628756 PECOS PAC ID: 6608832035 Enrollment ID: I20110228000453 |
| Provider Name | Akihiro Mizuta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386706646 PECOS PAC ID: 5092999318 Enrollment ID: I20110412000410 |
| Provider Name | Lihong Yan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477844363 PECOS PAC ID: 7416128699 Enrollment ID: I20110920000192 |
| Provider Name | Paul A Malabanan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467596940 PECOS PAC ID: 2567634306 Enrollment ID: I20111020000312 |
| Provider Name | Thomas A Woodbury |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609878115 PECOS PAC ID: 1850295197 Enrollment ID: I20120120000521 |
| Provider Name | Khadeer A Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588964456 PECOS PAC ID: 1658523279 Enrollment ID: I20121206000106 |
| Provider Name | Anil Khurana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871807933 PECOS PAC ID: 6800049727 Enrollment ID: I20121231000019 |
| Provider Name | Hooman Hormozian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891967030 PECOS PAC ID: 2264674498 Enrollment ID: I20130816000607 |
| Provider Name | Christina L Poon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013211135 PECOS PAC ID: 0941430227 Enrollment ID: I20140306000755 |
| Provider Name | Alna B Portugal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669813648 PECOS PAC ID: 6800027061 Enrollment ID: I20140401001543 |
| Provider Name | Hughes Mohlie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497065486 PECOS PAC ID: 5698998979 Enrollment ID: I20140514002125 |
| Provider Name | Arlene Fabian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376988899 PECOS PAC ID: 5799694030 Enrollment ID: I20140604001602 |
| Provider Name | Edward A Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770921058 PECOS PAC ID: 6507907946 Enrollment ID: I20140714000008 |
| Provider Name | Edward Pflaumer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801084561 PECOS PAC ID: 8123249786 Enrollment ID: I20141023001048 |
| Provider Name | Jovita Ezirim-salamialofoje |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114320124 PECOS PAC ID: 8022159748 Enrollment ID: I20150105001071 |
| Provider Name | Sherri Roberta Nielsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841695129 PECOS PAC ID: 8729302328 Enrollment ID: I20150129002137 |
| Provider Name | Alejandra Perez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184807943 PECOS PAC ID: 9234454760 Enrollment ID: I20150204001630 |
| Provider Name | Jonson J Lin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114101995 PECOS PAC ID: 4880772623 Enrollment ID: I20150211002217 |
| Provider Name | Sandra Quezada |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215245444 PECOS PAC ID: 2163740812 Enrollment ID: I20150409002081 |
| Provider Name | Sheila B. Hays |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497977110 PECOS PAC ID: 5991024416 Enrollment ID: I20150507002113 |
| Provider Name | Dorothy Nguyen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639312614 PECOS PAC ID: 7315252970 Enrollment ID: I20150812006956 |
| Provider Name | Tarek M Ezzeddine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740471879 PECOS PAC ID: 7315026697 Enrollment ID: I20151119000879 |
| Provider Name | Bianca Mercado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659623395 PECOS PAC ID: 4587964739 Enrollment ID: I20151119003081 |
| Provider Name | Rachel C Caudillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659418283 PECOS PAC ID: 9436454055 Enrollment ID: I20160219000601 |
| Provider Name | Christine B Cardenas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457658262 PECOS PAC ID: 0446556542 Enrollment ID: I20160316001483 |
| Provider Name | Janet Agu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982983508 PECOS PAC ID: 4183911928 Enrollment ID: I20160922001734 |
| Provider Name | Azadeh Golshani |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093064420 PECOS PAC ID: 8325329808 Enrollment ID: I20161221001655 |
| Provider Name | Stephanie Kleppe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669511002 PECOS PAC ID: 8123302684 Enrollment ID: I20170228001782 |
| Provider Name | Lisa N Von Zabern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952845372 PECOS PAC ID: 5698051795 Enrollment ID: I20170403002459 |
| Provider Name | Ajila Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508218280 PECOS PAC ID: 8527344084 Enrollment ID: I20170417002149 |
| Provider Name | Stephanie M Whittle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790003325 PECOS PAC ID: 6507081049 Enrollment ID: I20170605001977 |
| Provider Name | Jennifer E Villalba |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225178353 PECOS PAC ID: 4880971530 Enrollment ID: I20170905003468 |
| Provider Name | David J Melarkey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699186502 PECOS PAC ID: 8820363195 Enrollment ID: I20171012001771 |
| Provider Name | Tracy Le Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295249225 PECOS PAC ID: 8022377381 Enrollment ID: I20180111001518 |
| Provider Name | Jacob Noghreian |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558450122 PECOS PAC ID: 0042571416 Enrollment ID: I20180227001461 |
| Provider Name | Cindy Tafoya |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699059386 PECOS PAC ID: 8123382843 Enrollment ID: I20180504001783 |
| Provider Name | Dante D Millon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528354628 PECOS PAC ID: 4082978689 Enrollment ID: I20180508000552 |
| Provider Name | Shaunda Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629512306 PECOS PAC ID: 7517213937 Enrollment ID: I20180627001692 |
| Provider Name | Janayia C Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972904605 PECOS PAC ID: 1153677737 Enrollment ID: I20180712001126 |
| Provider Name | Emily A Morton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316231756 PECOS PAC ID: 3870831803 Enrollment ID: I20190215002289 |
| Provider Name | Ethel U Antonio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386778967 PECOS PAC ID: 5294074860 Enrollment ID: I20190226000465 |
| Provider Name | Seth E Chelliah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497126197 PECOS PAC ID: 7517292626 Enrollment ID: I20190711002493 |
| Provider Name | Shalbe N Ealey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225238694 PECOS PAC ID: 7416284963 Enrollment ID: I20190807001191 |
| Provider Name | Juan Navarro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912268657 PECOS PAC ID: 0749517969 Enrollment ID: I20190812001394 |
| Provider Name | Martina N Kashalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831678465 PECOS PAC ID: 7517200827 Enrollment ID: I20190823001618 |
| Provider Name | Kelly Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851844880 PECOS PAC ID: 1557690252 Enrollment ID: I20190905001417 |
| Provider Name | Honggyun Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033618509 PECOS PAC ID: 5395076418 Enrollment ID: I20191003002557 |
| Provider Name | Summer J Mcgeever |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1295059830 PECOS PAC ID: 9638392152 Enrollment ID: I20191213001126 |
| Provider Name | Mark T Gmoser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861662702 PECOS PAC ID: 7911331087 Enrollment ID: I20191223002109 |
| Provider Name | Sanghee Hong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083192116 PECOS PAC ID: 7517391550 Enrollment ID: I20191227000010 |
| Provider Name | Jim Hwang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841584950 PECOS PAC ID: 1052745833 Enrollment ID: I20200103000505 |
| Provider Name | Jessica L Meister |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649655713 PECOS PAC ID: 2668806365 Enrollment ID: I20200106002898 |
| Provider Name | John E Singidas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760020408 PECOS PAC ID: 9234565854 Enrollment ID: I20200130000777 |
| Provider Name | Amelle Joseph Baptiste Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952946956 PECOS PAC ID: 9032545439 Enrollment ID: I20200203002389 |
| Provider Name | Ada Angeles |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1386001519 PECOS PAC ID: 3274961347 Enrollment ID: I20200324001457 |
| Provider Name | Alycia Erin Wood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104112507 PECOS PAC ID: 2668805334 Enrollment ID: I20200422000860 |
| Provider Name | Linda Kit |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497194468 PECOS PAC ID: 0244545440 Enrollment ID: I20200424002001 |
| Provider Name | Nshan D Dekeyan |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1932623659 PECOS PAC ID: 5193147213 Enrollment ID: I20200618002116 |
| Provider Name | Kendal D Martindale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235672551 PECOS PAC ID: 2769895572 Enrollment ID: I20210114002399 |
| Provider Name | Ashley Cabadas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902218589 PECOS PAC ID: 1850709452 Enrollment ID: I20210420002530 |
| Provider Name | Tanisha L Pitre |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700925328 PECOS PAC ID: 8325457567 Enrollment ID: I20210429001648 |
| Provider Name | Ramiro A Trujillo Castro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306159686 PECOS PAC ID: 9133529076 Enrollment ID: I20210614002644 |
| Provider Name | Oluwatoyin Oladimeji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396345245 PECOS PAC ID: 1456751130 Enrollment ID: I20210617000933 |
| Provider Name | Bonnie M Kamp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689845307 PECOS PAC ID: 7315374790 Enrollment ID: I20210630002348 |
| Provider Name | Rosa Maria Aguero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215534888 PECOS PAC ID: 7517356207 Enrollment ID: I20211118002049 |
| Provider Name | Yonglin Zhang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245824127 PECOS PAC ID: 0749670388 Enrollment ID: I20211214000945 |
| Provider Name | Mina Youssef |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316562390 PECOS PAC ID: 5991196669 Enrollment ID: I20220107000439 |
| Provider Name | Yalittza Reyna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831487669 PECOS PAC ID: 8729470315 Enrollment ID: I20220111000663 |
| Provider Name | Neal E Schwartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164592127 PECOS PAC ID: 6103881388 Enrollment ID: I20220308001903 |
| Provider Name | Jacquelyn R Williams Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033731518 PECOS PAC ID: 5991190928 Enrollment ID: I20220309002702 |
| Provider Name | Kathleen Angela Baldo Bunag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588255053 PECOS PAC ID: 4183010481 Enrollment ID: I20220414001037 |
| Provider Name | Donara Gasanova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073809067 PECOS PAC ID: 2466849278 Enrollment ID: I20220426001997 |
| Provider Name | Denika Chacon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346715893 PECOS PAC ID: 3577950229 Enrollment ID: I20220427000961 |
| Provider Name | Edward Wang |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1811262884 PECOS PAC ID: 3779970652 Enrollment ID: I20220506001977 |
| Provider Name | Carolette King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780259655 PECOS PAC ID: 6709264641 Enrollment ID: I20220603002193 |
| Provider Name | Maritza Pelayo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083167589 PECOS PAC ID: 5092193581 Enrollment ID: I20220613002113 |
| Provider Name | Karine Setyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194464693 PECOS PAC ID: 2365823119 Enrollment ID: I20220725003563 |
| Provider Name | Ana Gomez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396118733 PECOS PAC ID: 1052793619 Enrollment ID: I20220729001500 |
| Provider Name | Jana M Given |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992381206 PECOS PAC ID: 9638552102 Enrollment ID: I20220816001435 |
| Provider Name | Naysan B Malakouti-nejad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558804450 PECOS PAC ID: 0941678270 Enrollment ID: I20221117002170 |
| Provider Name | Khanh N Mai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659869188 PECOS PAC ID: 6901275981 Enrollment ID: I20221214000737 |
| Provider Name | Ngozi S Chukwuemeka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194336974 PECOS PAC ID: 3072984848 Enrollment ID: I20230116000370 |
| Provider Name | Angelica A Tan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437860020 PECOS PAC ID: 9436519188 Enrollment ID: I20230713001917 |
| Provider Name | Brianna T Subero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932646619 PECOS PAC ID: 5294181699 Enrollment ID: I20231020001834 |
| Provider Name | Torrey Dooley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992480990 PECOS PAC ID: 0749631471 Enrollment ID: I20240108000987 |
| Provider Name | Judy L Canales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790945715 PECOS PAC ID: 8628420205 Enrollment ID: I20240118004418 |
| Provider Name | Lance T Espiritu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831966746 PECOS PAC ID: 1557701513 Enrollment ID: I20240424004116 |
St. Anthony Medical Centers Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6368 Hollywood Blvd, Hollywood, CA 90028 Phone: 323-469-5555 | |
Bethany Towers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1745 N Gramercy Pl, Hollywood, CA 90028 Phone: 323-467-3121 Fax: 323-469-0627 |