# MEDI MEDI COMMUNITY HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154892875
- **Authorized official:** ANDY PISKOULIAN (FOUNDER /CEO)
- **Authorized official phone:** (310) 200-7636

## Contact information

- **Practice address:** 11900 AVALON BLVD STE 100, LOS ANGELES, CA 90061-2867
- **Practice address phone:** (323) 999-2838
- **Mailing address:** 348 E OLIVE AVE STE K, BURBANK, CA 91502-1250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 183500000X | Pharmacist | — | NULL | — |
| 183500000X | Pharmacist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/06/2018
- **Last updated:** 12/19/2018