Provider Demographics
NPI:1093911943
Name:BARCO MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:BARCO MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCOHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-276-6933
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0355
Mailing Address - Country:US
Mailing Address - Phone:310-276-6933
Mailing Address - Fax:310-271-0980
Practice Address - Street 1:8929 WILSHIRE BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1938
Practice Address - Country:US
Practice Address - Phone:310-276-6933
Practice Address - Fax:310-271-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046420Medicaid
W8741Medicare PIN
CAGR0046420Medicaid