| None | |
|
21041 Parthenia St Unit 158 Canoga Park CA 91304-2080 | |
| (818) 267-8479 | |
| (818) 450-0272 |
| Full Name | None |
|---|---|
| Speciality | Family Medicine |
| Location | 21041 Parthenia St Unit 158, Canoga Park, California |
| Authorized Official Name and Position | Petros Hajian (ADMINISTRATOR/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8182678479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| None 21041 Parthenia St Unit 158 Canoga Park CA 91304-2080 Ph: (818) 267-8479 | None 21041 Parthenia St Unit 158 Canoga Park CA 91304-2080 Ph: (818) 267-8479 |
| NPI Number | 1043850662 |
|---|---|
| Provider Enumeration Date | 01/11/2020 |
| Last Update Date | 12/09/2021 |
| Medicare PECOS PAC ID | 3577992940 |
|---|---|
| Medicare Enrollment ID | O20200406002226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043850662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Prode P Pascual |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558454595 PECOS PAC ID: 5890822720 Enrollment ID: I20100423000367 |
| Provider Name | Lilibeth O Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497964688 PECOS PAC ID: 0446497655 Enrollment ID: I20130507000625 |
| Provider Name | Luis M Origel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447672696 PECOS PAC ID: 2961704283 Enrollment ID: I20160104002067 |
| Provider Name | Klar Pasilaban |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104371806 PECOS PAC ID: 2769764372 Enrollment ID: I20170116000193 |
| Provider Name | Lovelle C Valencia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306384987 PECOS PAC ID: 7618234907 Enrollment ID: I20171121001828 |
| Provider Name | Holy Dove Q Paule |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891327565 PECOS PAC ID: 9335557016 Enrollment ID: I20210419000501 |
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