Organization
SEPULVEDA PHYSICAL MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARCEY ANN HARRAKA (OWNER)
(310) 348-8298
Entity
Organization
Contact information
Practice address
8632 S SEPULVEDA BLVD STE 101, WESTCHESTER, CA 90045-4013
(310) 348-8298
Mailing address
8632 S SEPULVEDA BLVD STE 101, WESTCHESTER, CA 90045-4013
(310) 348-8298
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
11/14/2017
Last updated
03/17/2018
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