Provider Demographics
NPI:1245916048
Name:INNOVATIVE MEDICAL CARE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:INNOVATIVE MEDICAL CARE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-600-5213
Mailing Address - Street 1:3527 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1211
Mailing Address - Country:US
Mailing Address - Phone:323-600-5213
Mailing Address - Fax:
Practice Address - Street 1:3527 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:747-745-7771
Practice Address - Fax:818-484-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty