| |
3451 W Century Blvd Suite B-1 Inglewood CA 90303-1218 | |
(310) 677-9400 | |
(310) 677-9402 |
Full Name | |
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Speciality | General Practice |
Location | 3451 W Century Blvd, Inglewood, California |
Authorized Official Name and Position | David Razi (OWNER) |
Authorized Official Contact | 3106779400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3451 W Century Blvd Suite B-1 Inglewood CA 90303-1218 Ph: (310) 677-9400 | 3451 W Century Blvd Suite B-1 Inglewood CA 90303-1218 Ph: (310) 677-9400 |
NPI Number | 1528270147 |
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Provider Enumeration Date | 05/04/2007 |
Last Update Date | 08/01/2013 |
Medicare PECOS PAC ID | 8729056189 |
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Medicare Enrollment ID | O20040922001257 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528270147 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | A53431 (California) | Primary |
Provider Name | David F Razi |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1023045234 PECOS PAC ID: 0941281141 Enrollment ID: I20040527000547 |
Provider Name | Mehran Sourehnissani |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1992745285 PECOS PAC ID: 2365410727 Enrollment ID: I20040924000384 |
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