Healthcare Provider Details

I. General information

NPI: 1205353760
Provider Name (Legal Business Name): ALL CARE ONE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANTA FE AVENUE
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

7300 SANTA FE AVENUE
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 323-277-8900
  • Fax: 323-277-8902
Mailing address:
  • Phone: 323-277-8900
  • Fax: 323-277-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL KONONENKO
Title or Position: CFO
Credential:
Phone: 323-277-8900