MEDICARE: MEDI CURE HEALTH SERVICES, 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
1	251S00000X	Community/Behavioral Health Agency	190636AN	CA

General Provider Information

NPI Number	:	1497005524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDI CURE HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR STE 417
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	323-295-1136
Fax Number	:	323-295-1071

Provider Business Practice Location Address
First Line	:	3516 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2833
Country	:	US
Telephone Number	:	323-295-1136
Fax Number	:	323-295-1071

Authorized Official
Title or Position	:	CEO/EXECUTIVE DIRECTOR
Name	:	DR. JOSEPHINE C. KANNIKE-MARTINS
Credential	:	PHD., RD
Telephone Number	:	323-295-1136

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	09/17/2012

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