Basic Information
| Provider Information | |||||||||
| NPI: | 1720402050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APOLLOMED CARE CLINIC A PROFESSIONAL CORPORATION | ||||||||
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| OtherOrganizationName: | FIGUEROA FAMILY MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 5425 N FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900424117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232580015 | ||||||||
| FaxNumber: | 3232586470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2014 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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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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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.