MEDICARE: LOS ANGELES HEALTH CLINIC, LLC

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	213E00000X	Podiatrist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1942621206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES HEALTH CLINIC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 76002
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92809-7602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 N VERMONT AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1764
Country	:	US
Telephone Number	:	323-666-1894
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GEORGE YOUSSEF
Credential	:
Telephone Number	:	714-533-4362

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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