Organization
ATLANTIC AVENUE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH IVOR MOOTOO (MD)
(323) 562-3414
Entity
Organization
Contact information
Practice address
3737 MARTIN LUTHER KING JR BLVD STE 333, LYNWOOD, CA 90262-3528
(323) 562-3414
(323) 562-3100
Mailing address
PO BOX 619, LYNWOOD, CA 90262-0619
(323) 562-3414
(323) 562-3100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A35223
CA
Other
Enumeration date
06/30/2005
Last updated
10/16/2018
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