Organization
ANGELES COMPREHENSIVE COMMUNITY CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIANA KAZAROVA (ADMINISTRATOR)
(323) 255-5225
Entity
Organization
Contact information
Practice address
3920 EAGLE ROCK BLVD., SUITE A, LOS ANGELES, CA 90065-3606
(323) 255-5225
(323) 255-5229
Mailing address
3920 EAGLE ROCK BLVD., SUITE A, LOS ANGELES, CA 90065-3606
(323) 255-5225
(323) 255-5229
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
550000708
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326349960
NPI
CA
01
—
1427003300
NPI
CA
01
—
1427355981
NPI
CA
05
—
1457470684
—
CA
01
—
1811043474
NPI
CA
01
—
8370190013
CIGNA
CA
01
—
91355
HEALTHY FAMILY ENROLLMENT ENTITY
CA
01
—
CB217375
MEDICARE PTAN
CA
01
—
G56432F11
CARE 1ST
CA
01
—
G56432MM2
LA CARE
CA
01
—
OO3991
HEALTH NET
CA
01
—
OXG182
BLUE CROSS
CA
01
—
ZZZ552884
BLUE SHIELD
CA
Enumeration date
03/28/2007
Last updated
08/26/2014
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