Healthcare Provider Details

I. General information

NPI: 1265470868
Provider Name (Legal Business Name): IDEAL HEALTH CARE AND MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 320
GLENDALE CA
91204-2561
US

IV. Provider business mailing address

1500 S CENTRAL AVE STE 320
GLENDALE CA
91204-2561
US

V. Phone/Fax

Practice location:
  • Phone: 818-396-5670
  • Fax: 818-396-5672
Mailing address:
  • Phone: 818-396-5670
  • Fax: 818-396-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: ARNEL MONTELOYOLA JOAQUIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 213-880-3305