Provider Demographics
NPI:1609092162
Name:TERESA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:TERESA MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARJANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-383-9955
Mailing Address - Street 1:2675 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2810
Mailing Address - Country:US
Mailing Address - Phone:213-383-9955
Mailing Address - Fax:
Practice Address - Street 1:2675 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2810
Practice Address - Country:US
Practice Address - Phone:213-383-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15628207Q00000X, 208000000X
CAA70290207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095860Medicaid
CAGR0095860Medicaid