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Organization
MENSA FAMILY CLINIC INC
Active
Organization
MENSA FAMILY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SVETLANA VIKTOROVNA GORELIKOVA MD (PRESIDENT)
(818) 945-5502
Entity
Organization
Contact information
Practice address
1110 S GLENDALE AVE STE E, GLENDALE, CA 91205-5623
(818) 945-5502
(818) 945-5595
Mailing address
1110 S GLENDALE AVE STE E, GLENDALE, CA 91205-5623
(818) 945-5502
(818) 945-5595
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A102339
LICENSE
CA
Enumeration date
02/28/2019
Last updated
02/28/2019
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