| |
10200 Sepulveda Blvd Ste 140 Mission Hills CA 91345-3323 | |
(818) 610-6536 | |
(818) 450-0133 |
Full Name | |
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Speciality | Family Medicine |
Location | 10200 Sepulveda Blvd Ste 140, Mission Hills, California |
Authorized Official Name and Position | Luis Manuel Origel (PRESIDENT/CEO) |
Authorized Official Contact | 8186106536 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10200 Sepulveda Blvd Ste 140 Mission Hills CA 91345-3323 Ph: (818) 610-6536 | 10200 Sepulveda Blvd Ste 140 Mission Hills CA 91345-3323 Ph: (818) 610-6536 |
NPI Number | 1548856586 |
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Provider Enumeration Date | 12/14/2020 |
Last Update Date | 04/13/2023 |
Medicare PECOS PAC ID | 2163830217 |
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Medicare Enrollment ID | O20210409001544 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548856586 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Vincent J Bennett |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1982650776 PECOS PAC ID: 5496644478 Enrollment ID: I20040315001384 |
Provider Name | Luis M Origel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447672696 PECOS PAC ID: 2961704283 Enrollment ID: I20160104002067 |
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