Basic Information
| Provider Information | |||||||||
| NPI: | 1538507710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APOLLOMED CARE CLINIC, A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 N BRAND BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912031247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188395200 | ||||||||
| FaxNumber: | 8188395190 | ||||||||
| Practice Location | |||||||||
| Address1: | 9449 SAN FERNANDO RD | ||||||||
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| City: | SUN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913521421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188395200 | ||||||||
| FaxNumber: | 8188395190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2013 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOSSEINION | ||||||||
| AuthorizedOfficialFirstName: | WARREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8188395200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A69768 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.