Provider Demographics
NPI:1760698740
Name:ALL FAMILY NEIGHBORHOOD MEDICAL CLINIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ALL FAMILY NEIGHBORHOOD MEDICAL CLINIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-238-0800
Mailing Address - Street 1:1379 W PARK WESTERN DR
Mailing Address - Street 2:SUITE 322
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2217
Mailing Address - Country:US
Mailing Address - Phone:323-238-0800
Mailing Address - Fax:323-238-0875
Practice Address - Street 1:874 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1205
Practice Address - Country:US
Practice Address - Phone:323-238-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty