Organization
SOUTHERN CALIFORNIA SPECIALTY CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOSTAFA ADAM DARVISH (EXECUTIVE DIRECTOR)
(714) 893-4541
Entity
Organization
Contact information
Practice address
14900 IMPERIAL HWY, LA MIRADA, CA 90638-2172
(562) 944-1900
(562) 906-3455
Mailing address
14900 IMPERIAL HWY, LA MIRADA, CA 90638-2172
(562) 944-1900
(562) 906-3455
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HSP32028F
—
CA
01
—
ZZZB1919Z
BLUE CROSS
—
Enumeration date
08/20/2009
Last updated
08/20/2009
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