Provider Demographics
NPI:1770235962
Name:QUICKMED INC
Entity Type:Organization
Organization Name:QUICKMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:HOUTAN
Authorized Official - Last Name:MOSSAZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-4923
Mailing Address - Street 1:2664 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2604
Mailing Address - Country:US
Mailing Address - Phone:310-666-4923
Mailing Address - Fax:
Practice Address - Street 1:2664 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2604
Practice Address - Country:US
Practice Address - Phone:310-666-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service