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NPI Code Detail

MEDICARE: CENTRAL MEDICAL CLINIC INC

MEDICARE: CENTRAL MEDICAL CLINIC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1265987143
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL MEDICAL CLINIC INC
Provider Business Mailing Address
First Line : 2118 S CENTRAL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-1237
Country : US
Telephone Number : 213-493-4664
Fax Number :
Provider Business Practice Location Address
First Line : 2118 S CENTRAL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-1237
Country : US
Telephone Number : 213-493-4664
Fax Number : 213-493-4665
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : VICTORIA BOROVSKY
Credential : M. D.
Telephone Number : 213-493-4664
Provider Enumeration Date : 08/19/2016
Last Update Date : 12/20/2016

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Directions to “CENTRAL MEDICAL CLINIC INC ” Practice Location

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