Provider Demographics
NPI:1235606294
Name:GHIASSI, MD INCORPORATED
Entity Type:Organization
Organization Name:GHIASSI, MD INCORPORATED
Other - Org Name:GHIASSI MD INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-824-1262
Mailing Address - Street 1:11645 WILSHIRE BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6807
Mailing Address - Country:US
Mailing Address - Phone:310-824-1262
Mailing Address - Fax:310-824-5190
Practice Address - Street 1:11645 WILSHIRE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6807
Practice Address - Country:US
Practice Address - Phone:310-824-1262
Practice Address - Fax:310-824-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty