Provider Demographics
NPI:1184754996
Name:CLINICA DE LOS ANGELES MEDICAL GROUP
Entity type:Organization
Organization Name:CLINICA DE LOS ANGELES MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-231-7700
Mailing Address - Street 1:4301 S FIGUEROA ST STE F
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2671
Mailing Address - Country:US
Mailing Address - Phone:323-231-7700
Mailing Address - Fax:323-231-0799
Practice Address - Street 1:4301 S FIGUEROA ST STE F
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2671
Practice Address - Country:US
Practice Address - Phone:323-231-7700
Practice Address - Fax:323-231-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty