| Vermont Family Care Medical Clinic Inc | |
|
640 N Arden Blvd Los Angeles CA 90004-1202 | |
| (323) 228-4399 | |
| Not Available |
| Full Name | Vermont Family Care Medical Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 640 N Arden Blvd, Los Angeles, California |
| Authorized Official Name and Position | John Rastegar (PRESIDENT) |
| Authorized Official Contact | 3232284399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vermont Family Care Medical Clinic Inc 640 N Arden Blvd Los Angeles CA 90004-1202 Ph: (323) 228-4399 | Vermont Family Care Medical Clinic Inc 640 N Arden Blvd Los Angeles CA 90004-1202 Ph: (323) 228-4399 |
| NPI Number | 1437350014 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 06/16/2014 |
| Medicare PECOS PAC ID | 5496817827 |
|---|---|
| Medicare Enrollment ID | O20081218000797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437350014 | NPI | - | NPPES |
| 1609936483 | Other | CA | PERSONAL NPI |
| 00A538471 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A53847 (California) | Primary |
| Provider Name | John H Rastegar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609936483 PECOS PAC ID: 2163583964 Enrollment ID: I20081211000853 |
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