MEDICARE: HOMA 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	207R00000X	Internal Medicine Physician	A1006243	CA

General Provider Information

NPI Number	:	1992136964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMA INC

Provider Business Mailing Address
First Line	:	6428 COLDWATER CAN. AVE.
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-308-6440
Fax Number	:	818-308-6351

Provider Business Practice Location Address
First Line	:	6428 COLDWATER CYN AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1113
Country	:	US
Telephone Number	:	818-308-6440
Fax Number	:	818-308-6351

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HOVSEP G MAHDESSIAN
Credential	:	M.D
Telephone Number	:	818-308-6440

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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Directions to “HOMA INC ” Practice Location

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