Provider Demographics
NPI:1912257650
Name:NEIGHBOR HOOD MEDICAL CLINIC
Entity Type:Organization
Organization Name:NEIGHBOR HOOD MEDICAL CLINIC
Other - Org Name:NEIGHBOR HOOD MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARVIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-750-2325
Mailing Address - Street 1:723 E MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-3632
Mailing Address - Country:US
Mailing Address - Phone:323-750-2325
Mailing Address - Fax:323-750-2055
Practice Address - Street 1:723 E MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-3632
Practice Address - Country:US
Practice Address - Phone:323-750-2325
Practice Address - Fax:323-750-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7522261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care