Healthcare Provider Details

I. General information

NPI: 1811570633
Provider Name (Legal Business Name): NEO MEDICAL CENTRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 307
HARBOR CITY CA
90710-2085
US

IV. Provider business mailing address

1403 LOMITA BLVD STE 307
HARBOR CITY CA
90710-2085
US

V. Phone/Fax

Practice location:
  • Phone: 424-352-0326
  • Fax:
Mailing address:
  • Phone: 424-352-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER I ESTEY
Title or Position: SECRETARY
Credential: MLP-NURSE PRACTITION
Phone: 424-352-0326