Provider Demographics
NPI:1659379634
Name:DOCTOR PAUL MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:DOCTOR PAUL MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEZIA
Authorized Official - Middle Name:OGUGUA
Authorized Official - Last Name:AZINGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-290-2832
Mailing Address - Street 1:501 E HARDY ST STE 220
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4054
Mailing Address - Country:US
Mailing Address - Phone:323-290-2832
Mailing Address - Fax:323-290-2836
Practice Address - Street 1:501 E HARDY ST STE 220
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:323-290-2832
Practice Address - Fax:323-290-2836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:0000992894-0001-6
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53449261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534491Medicaid
CA00A53449Medicaid
CA00A534492Medicaid
CAA53449AMedicare ID - Type UnspecifiedCRENSHAW
CA00A534492Medicaid
CA00A534491Medicaid
CA00A53449Medicaid