Provider Demographics
NPI:1851974760
Name:ALLIED PRIMARY CARE CLINIC, INC.
Entity Type:Organization
Organization Name:ALLIED PRIMARY CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-592-5906
Mailing Address - Street 1:10481 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5031
Mailing Address - Country:US
Mailing Address - Phone:310-592-5906
Mailing Address - Fax:310-868-2500
Practice Address - Street 1:10481 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5031
Practice Address - Country:US
Practice Address - Phone:310-592-5906
Practice Address - Fax:310-868-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38224BMedicaid