Provider Demographics
NPI:1518729219
Name:MEDACCESS COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:MEDACCESS COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOUSHEG
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-426-0810
Mailing Address - Street 1:2629 N KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2113
Mailing Address - Country:US
Mailing Address - Phone:818-426-0810
Mailing Address - Fax:818-450-0451
Practice Address - Street 1:10823 OXNARD ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-5020
Practice Address - Country:US
Practice Address - Phone:818-426-0810
Practice Address - Fax:818-450-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care