Provider Demographics
NPI:1720571938
Name:PLAYA MEDICAL CLINIC
Entity Type:Organization
Organization Name:PLAYA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAEBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-339-8310
Mailing Address - Street 1:8320 LINCOLN BLVD STE 103A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2466
Mailing Address - Country:US
Mailing Address - Phone:310-645-2455
Mailing Address - Fax:
Practice Address - Street 1:8320 LINCOLN BLVD STE 103A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2466
Practice Address - Country:US
Practice Address - Phone:310-645-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care