Organization
CALIFORNIACARECORP
Active
Parent organization
CALIFORNIACARECORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
CALIFORNIACARECORP
Authorized official
MICHAEL MING-TA SU M.D. (PROVIDER)
(818) 551-0026
Entity
Organization
Contact information
Practice address
127 S BRAND BLVD # 241, GLENDALE, CA 91204-1342
(818) 551-0026
Mailing address
127 S BRAND BLVD # 241, GLENDALE, CA 91204-1342
(818) 551-0026
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
A91343
CA
Other
Enumeration date
06/21/2010
Last updated
06/21/2010
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