MEDICARE: MEDRO MANAGEMEN COMAPNY 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	251G00000X	Community Based Hospice Care Agency		CA

General Provider Information

NPI Number	:	1821197070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDRO MANAGEMEN COMAPNY INC.

Provider Business Mailing Address
First Line	:	832 GLENMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3204
Country	:	US
Telephone Number	:	310-625-6642
Fax Number	:	310-276-4795

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	SUITE 1807
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	310-625-6642
Fax Number	:	310-276-4795

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HOMAYOUN SHARIM
Credential	:	M.D.
Telephone Number	:	310-625-6642

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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