Provider Demographics
NPI:1528344686
Name:ANGELES MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:ANGELES MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARVENAZ
Authorized Official - Middle Name:SAADAT
Authorized Official - Last Name:MOBASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-457-4000
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0299
Mailing Address - Country:US
Mailing Address - Phone:213-457-4000
Mailing Address - Fax:213-457-6000
Practice Address - Street 1:204 E PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2508
Practice Address - Country:US
Practice Address - Phone:213-457-4000
Practice Address - Fax:213-457-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB348AMedicare PIN