Provider Demographics
NPI:1649209743
Name:HOLLYWOOD CROSS MEDICAL CLINIC
Entity Type:Organization
Organization Name:HOLLYWOOD CROSS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGDI
Authorized Official - Middle Name:RIAD
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-463-6881
Mailing Address - Street 1:1110 N WESTERN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1088
Mailing Address - Country:US
Mailing Address - Phone:323-463-6881
Mailing Address - Fax:323-463-6831
Practice Address - Street 1:1110 N WESTERN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1088
Practice Address - Country:US
Practice Address - Phone:323-463-6881
Practice Address - Fax:323-463-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83783ZMedicaid
CAZZZ83783ZMedicaid