Provider Demographics
NPI:1457697310
Name:VERMONT WORKERS COMP CENTER, INC.
Entity Type:Organization
Organization Name:VERMONT WORKERS COMP CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL ASMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-660-5624
Mailing Address - Street 1:1234 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1704
Mailing Address - Country:US
Mailing Address - Phone:323-660-5624
Mailing Address - Fax:323-389-9128
Practice Address - Street 1:1234 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-660-5624
Practice Address - Fax:323-389-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA619232083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619230Medicaid