# SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Superior Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770774366
- **Authorized official:** REZA RAY EHSAN M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 390-9551

## Contact information

- **Practice address:** 11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
- **Practice address phone:** (310) 390-9551
- **Practice address fax:** (310) 390-9296
- **Mailing address:** 11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
- **Mailing address phone:** (310) 390-9551
- **Mailing address fax:** (310) 390-9296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 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

- **Enumeration date:** 08/07/2007
- **Last updated:** 02/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1770774366 | — | CA |