Provider Demographics
NPI:1447592779
Name:HOLLYWOOD WALK IN CLINIC
Entity Type:Organization
Organization Name:HOLLYWOOD WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEONZA
Authorized Official - Middle Name:
Authorized Official - Last Name:THYMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-848-4522
Mailing Address - Street 1:6430 SELMA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6430 SELMA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7311
Practice Address - Country:US
Practice Address - Phone:323-848-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22876261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care