Provider Demographics
NPI:1942354857
Name:SENIOR CARE CLINIC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SENIOR CARE CLINIC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZMY
Authorized Official - Middle Name:FOUAD
Authorized Official - Last Name:GHALY
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:323-307-0800
Mailing Address - Street 1:1700 CESAR CHAVEZ AVE
Mailing Address - Street 2:# 3900
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2414
Mailing Address - Country:US
Mailing Address - Phone:323-307-0800
Mailing Address - Fax:323-307-0803
Practice Address - Street 1:1700 CESAR CHAVEZ AVE
Practice Address - Street 2:# 3900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2414
Practice Address - Country:US
Practice Address - Phone:323-307-0800
Practice Address - Fax:323-307-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51085207RG0300X
CAA72860207RG0300X
CAA77545207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089680Medicaid
CAGR0089680Medicaid