Provider Demographics
NPI:1205056033
Name:TERESA MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:TERESA MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARJANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-660-5900
Mailing Address - Street 1:326 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3511
Mailing Address - Country:US
Mailing Address - Phone:323-660-5900
Mailing Address - Fax:
Practice Address - Street 1:1407 N VERMONT AVE # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6023
Practice Address - Country:US
Practice Address - Phone:310-908-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15628207Q00000X, 208000000X
CAA70290207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090191Medicaid
CAGR0090191Medicaid