| Primary Care Health Clinic | |
|
1601 W Washington Blvd Los Angeles CA 90007-1116 | |
| (310) 701-6703 | |
| Not Available |
| Full Name | Primary Care Health Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1601 W Washington Blvd, Los Angeles, California |
| Authorized Official Name and Position | Ndika Fomukong (CEO) |
| Authorized Official Contact | 3107016703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Health Clinic 1601 W Washington Blvd Los Angeles CA 90007-1116 Ph: (310) 701-6703 | Primary Care Health Clinic 1601 W Washington Blvd Los Angeles CA 90007-1116 Ph: (310) 701-6703 |
| NPI Number | 1891134268 |
|---|---|
| Provider Enumeration Date | 06/19/2013 |
| Last Update Date | 01/13/2016 |
| Medicare PECOS PAC ID | 0345541488 |
|---|---|
| Medicare Enrollment ID | O20151215002445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891134268 | NPI | - | NPPES |
| Provider Name | Brownell H Payne |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1720156490 PECOS PAC ID: 2365478831 Enrollment ID: I20050715000461 |
| Provider Name | Cadrin E Gill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891851861 PECOS PAC ID: 3476748880 Enrollment ID: I20101123001083 |
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