Provider Demographics
NPI:1891758751
Name:ALLERGY ASTHMA CARE CENTER, INC
Entity Type:Organization
Organization Name:ALLERGY ASTHMA CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-393-1550
Mailing Address - Street 1:11500 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1524
Mailing Address - Country:US
Mailing Address - Phone:310-393-1550
Mailing Address - Fax:310-478-3601
Practice Address - Street 1:11500 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1524
Practice Address - Country:US
Practice Address - Phone:310-393-1550
Practice Address - Fax:310-478-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20780Medicare PIN