Provider Demographics
NPI:1487832655
Name:SOCAL HEALTHNET INC
Entity Type:Organization
Organization Name:SOCAL HEALTHNET INC
Other - Org Name:ST. LUKE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-461-3888
Mailing Address - Street 1:5912 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2043
Mailing Address - Country:US
Mailing Address - Phone:323-461-3888
Mailing Address - Fax:323-461-3250
Practice Address - Street 1:5912 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2043
Practice Address - Country:US
Practice Address - Phone:323-461-3888
Practice Address - Fax:323-461-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR008540261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty