Provider Demographics
NPI:1972563617
Name:MEDICAL GROUP OF PARAMOUNT, INC.
Entity Type:Organization
Organization Name:MEDICAL GROUP OF PARAMOUNT, INC.
Other - Org Name:CLINICA MEDICA HISPANA MEDICAL CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:HORACIO
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-630-1991
Mailing Address - Street 1:14906 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3409
Mailing Address - Country:US
Mailing Address - Phone:562-630-1991
Mailing Address - Fax:562-630-0145
Practice Address - Street 1:14906 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3409
Practice Address - Country:US
Practice Address - Phone:562-630-1991
Practice Address - Fax:562-630-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88689207Q00000X
CAA37605207V00000X
CAA31583208D00000X
CAPA 15959363A00000X
CAPA 18278363A00000X
CANP 8951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060690Medicaid
CAGR0060690Medicaid
CAA26538Medicare UPIN