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Organization
SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.
Active
Organization
SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.
Active
Other names
Superior Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REZA RAY EHSAN M.D. (MEDICAL DIRECTOR)
(310) 390-9551
Entity
Organization
Contact information
Practice address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Mailing address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261QE0002X
Emergency Care Clinic/Center
A50372
CA
261QM1300X
Multi-Specialty Clinic/Center
A50372
CA
261QM2500X
Medical Specialty Clinic/Center
A50372
CA
261QP3300X
Pain Clinic/Center
A50372
CA
261QU0200X
Urgent Care Clinic/Center
A50312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770774366
—
CA
Enumeration date
08/07/2007
Last updated
02/22/2010
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