| Shared Harvest Mycovidmd | |
|
10000 Washington Blvd Ste 600 Culver City CA 90232-2783 | |
| (323) 880-0121 | |
| (801) 665-5652 |
| Full Name | Shared Harvest Mycovidmd |
|---|---|
| Speciality | Clinic/Center |
| Location | 10000 Washington Blvd Ste 600, Culver City, California |
| Authorized Official Name and Position | Nanaefua Afoh-manin (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 9177483832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shared Harvest Mycovidmd 23934 Decorah Rd Diamond Bar CA 91765-1407 Ph: (917) 748-3832 | Shared Harvest Mycovidmd 10000 Washington Blvd Ste 600 Culver City CA 90232-2783 Ph: (323) 880-0121 |
| NPI Number | 1932789757 |
|---|---|
| Provider Enumeration Date | 04/14/2021 |
| Last Update Date | 08/04/2022 |
| Medicare PECOS PAC ID | 7315322880 |
|---|---|
| Medicare Enrollment ID | O20220920000810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932789757 | NPI | - | NPPES |
| B4082017 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Nanaefua B Afoh-manin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760646897 PECOS PAC ID: 5294905451 Enrollment ID: I20140910000668 |
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