| San Judas Community Health Center, Inc. | |
|
1080 N Western Ave Los Angeles CA 90029-2310 | |
| (323) 957-3737 | |
| (323) 957-3700 |
| Full Name | San Judas Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1080 N Western Ave, Los Angeles, California |
| Authorized Official Name and Position | Nejat Rostami (CEO) |
| Authorized Official Contact | 3107804674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Judas Community Health Center, Inc. 1080 N Western Ave Los Angeles CA 90029-2310 Ph: (323) 957-3737 | San Judas Community Health Center, Inc. 1080 N Western Ave Los Angeles CA 90029-2310 Ph: (323) 957-3737 |
| NPI Number | 1184134827 |
|---|---|
| Provider Enumeration Date | 10/09/2017 |
| Last Update Date | 10/09/2017 |
| Medicare PECOS PAC ID | 2365788999 |
|---|---|
| Medicare Enrollment ID | O20190117003329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184134827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nejat Rostami |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114064987 PECOS PAC ID: 6204818313 Enrollment ID: I20041005001314 |
| Provider Name | Minal W Borsada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457485500 PECOS PAC ID: 4587825781 Enrollment ID: I20120416000437 |
| Provider Name | Babak B Rostami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811188048 PECOS PAC ID: 3678895430 Enrollment ID: I20141205000015 |
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