Provider Demographics
NPI:1093767105
Name:ANIL MOHIN MD, FACC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANIL MOHIN MD, FACC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:CLINICA MEDICA ALVARADO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-252-2225
Mailing Address - Street 1:745 SOUTH ALVARADO STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4021
Mailing Address - Country:US
Mailing Address - Phone:213-252-2225
Mailing Address - Fax:213-252-2244
Practice Address - Street 1:745 SOUTH ALVARADO STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4021
Practice Address - Country:US
Practice Address - Phone:213-252-2225
Practice Address - Fax:213-252-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40506207RC0000X
CAG10040207RG0100X
CA00A444940207V00000X
CAG45111207W00000X
CAG81239208800000X
CAA66159208D00000X
CAE4013213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E46090Medicaid
CAZZZ66511ZOtherBLUE SHIELD GROUP PIN
CAZZZ66511ZOtherBLUE SHIELD GROUP PIN
CA207RC0000X - INTERNAMedicare UPIN