| Salam F Alkasspooles M D Amc | |
|
11633 San Vicente Blvd Suite 314 Los Angeles CA 90049-6511 | |
| (310) 207-0020 | |
| (310) 207-0030 |
| Full Name | Salam F Alkasspooles M D Amc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11633 San Vicente Blvd, Los Angeles, California |
| Authorized Official Name and Position | Salam F Alkasspooles (PRESIDENT) |
| Authorized Official Contact | 3106520092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salam F Alkasspooles M D Amc 11633 San Vicente Blvd Ste 314 Los Angeles CA 90049-6514 Ph: (310) 207-0020 | Salam F Alkasspooles M D Amc 11633 San Vicente Blvd Suite 314 Los Angeles CA 90049-6511 Ph: (310) 207-0020 |
| NPI Number | 1609118983 |
|---|---|
| Provider Enumeration Date | 03/25/2013 |
| Last Update Date | 01/24/2019 |
| Medicare PECOS PAC ID | 5395981732 |
|---|---|
| Medicare Enrollment ID | O20130409000565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609118983 | NPI | - | NPPES |
| 00818020 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (California) | Primary |
| Provider Name | Salam F Alkasspooles |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1548319965 PECOS PAC ID: 4587622238 Enrollment ID: I20041228000405 |
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