Provider Demographics
NPI:1558791251
Name:ANGELUS MEDICAL CLINIC MULTISPECIALTY GROUP, INC.
Entity Type:Organization
Organization Name:ANGELUS MEDICAL CLINIC MULTISPECIALTY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NEHZAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKAKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-2670
Mailing Address - Street 1:3444 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1708
Mailing Address - Country:US
Mailing Address - Phone:323-264-2670
Mailing Address - Fax:323-264-5752
Practice Address - Street 1:3444 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1708
Practice Address - Country:US
Practice Address - Phone:323-264-2670
Practice Address - Fax:323-264-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty