Provider Demographics
NPI:1669533907
Name:DOROTHY MAE MEDICAL CLINIC INC.
Entity type:Organization
Organization Name:DOROTHY MAE MEDICAL CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-600-6046
Mailing Address - Street 1:PO BOX 5167
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-5167
Mailing Address - Country:US
Mailing Address - Phone:323-750-1196
Mailing Address - Fax:323-750-0330
Practice Address - Street 1:8880 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3635
Practice Address - Country:US
Practice Address - Phone:323-750-1196
Practice Address - Fax:323-750-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064610261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14542OtherGROUP PTAN