Provider Demographics
NPI:1073934865
Name:APOLLOMED ACO
Entity Type:Organization
Organization Name:APOLLOMED ACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-839-5200
Mailing Address - Street 1:700 N BRAND BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1247
Mailing Address - Country:US
Mailing Address - Phone:818-839-5200
Mailing Address - Fax:
Practice Address - Street 1:700 N BRAND BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1247
Practice Address - Country:US
Practice Address - Phone:818-839-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty