Healthcare Provider Details

I. General information

NPI: 1073544714
Provider Name (Legal Business Name): THE ANGELES CLINIC AND RESEARCH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-6647
US

IV. Provider business mailing address

11818 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-6647
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-2121
  • Fax: 310-496-0679
Mailing address:
  • Phone: 310-231-2121
  • Fax: 310-496-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NANAZ F AMINI
Title or Position: ADMINISTRATOR
Credential: PHARMD
Phone: 310-231-2180