Organization
SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.
Active
Other names
Superior Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REZA RAY EHSAN M.D. (MEDICAL DIRECTOR)
(310) 390-9551
Entity
Organization
Contact information
Practice address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Mailing address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261QE0002X
Emergency Care Clinic/Center
A50372
CA
261QM1300X
Multi-Specialty Clinic/Center
A50372
CA
261QM2500X
Medical Specialty Clinic/Center
A50372
CA
261QP3300X
Pain Clinic/Center
A50372
CA
261QU0200X
Urgent Care Clinic/Center
A50312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770774366
—
CA
Enumeration date
08/07/2007
Last updated
02/22/2010
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