Provider Demographics
NPI:1457447393
Name:ANJANETTE HOGAN,MD,INC
Entity Type:Organization
Organization Name:ANJANETTE HOGAN,MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-296-0150
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:#409
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-532-0308
Mailing Address - Fax:310-532-0889
Practice Address - Street 1:550 W REGENT ST
Practice Address - Street 2:UNIT #319
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1080
Practice Address - Country:US
Practice Address - Phone:310-463-5338
Practice Address - Fax:310-532-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00021705320019261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care