Provider Demographics
NPI:1548445786
Name:HEALTH CARE 2000
Entity type:Organization
Organization Name:HEALTH CARE 2000
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:YERMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-581-6588
Mailing Address - Street 1:2402 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5727
Mailing Address - Country:US
Mailing Address - Phone:323-581-6588
Mailing Address - Fax:323-581-1812
Practice Address - Street 1:2402 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5727
Practice Address - Country:US
Practice Address - Phone:323-581-6588
Practice Address - Fax:323-581-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078550Medicaid
CAE82330Medicare UPIN
CAW11655Medicare PIN