| Vip Medical Concierge A Medical Corporation | |
|
4560 Admiralty Way Ste 200b Marina Del Rey CA 90292-5425 | |
| (818) 813-2273 | |
| (818) 471-4919 |
| Full Name | Vip Medical Concierge A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 4560 Admiralty Way Ste 200b, Marina Del Rey, California |
| Authorized Official Name and Position | Robert Baker (CFO) |
| Authorized Official Contact | 8183953060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vip Medical Concierge A Medical Corporation 1236 E Harvard St Glendale CA 91205-1412 Ph: (818) 813-2273 | Vip Medical Concierge A Medical Corporation 4560 Admiralty Way Ste 200b Marina Del Rey CA 90292-5425 Ph: (818) 813-2273 |
| NPI Number | 1962008003 |
|---|---|
| Provider Enumeration Date | 12/04/2020 |
| Last Update Date | 12/04/2020 |
| Medicare PECOS PAC ID | 9638578669 |
|---|---|
| Medicare Enrollment ID | O20210525001627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962008003 | NPI | - | NPPES |
| Provider Name | Shahram Abrishamy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649492448 PECOS PAC ID: 5294766770 Enrollment ID: I20050824000723 |
| Provider Name | Robert Wayne Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689225427 PECOS PAC ID: 9931534906 Enrollment ID: I20200121002493 |
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