Organization
CLOVER MEDICAL CORPORATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCH RUBIN (PRESIDENT)
(818) 762-8702
Entity
Organization
Contact information
Practice address
12134 VICTORY BLVD, SUITE C, NORTH HOLLYWOOD, CA 91606-3205
(818) 762-8702
(818) 761-2583
Mailing address
12134 VICTORY BLVD, SUITE C, NORTH HOLLYWOOD, CA 91606-3205
(818) 762-8702
(818) 761-2583
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
12/17/2011
Last updated
05/25/2016
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