Provider Demographics
NPI:1083767875
Name:NUEVA ESPERANZA HEALTHCARE MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:NUEVA ESPERANZA HEALTHCARE MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDESSOUKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-778-8485
Mailing Address - Street 1:1704 W MANCHESTER AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3056
Mailing Address - Country:US
Mailing Address - Phone:323-778-8485
Mailing Address - Fax:
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3034
Practice Address - Country:US
Practice Address - Phone:323-778-8485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty