Provider Demographics
NPI:1891039228
Name:AMERICAN CARDIOCARE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:AMERICAN CARDIOCARE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKONKWOAGUOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-490-2322
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-0425
Mailing Address - Country:US
Mailing Address - Phone:562-591-9000
Mailing Address - Fax:
Practice Address - Street 1:1125 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3911
Practice Address - Country:US
Practice Address - Phone:562-591-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP39403261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty