Organization
SAN JOSE COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REZA DANESH MD (CEO)
(310) 349-8338
Entity
Organization
Contact information
Practice address
11950 INGLEWOOD AVE, HAWTHORNE, CA 90250
(310) 349-8338
(310) 349-8340
Mailing address
PO BOX 903, PALOS VERDES ESTATES, CA 90274-0903
(310) 349-8338
(310) 349-8340
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A055334
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A553341
—
CA
Enumeration date
03/25/2007
Last updated
06/18/2018
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