Healthcare Provider Details

I. General information

NPI: 1609092162
Provider Name (Legal Business Name): TERESA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 W OLYMPIC BLVD
LOS ANGELES CA
90006-2810
US

IV. Provider business mailing address

2675 W OLYMPIC BLVD
LOS ANGELES CA
90006-2810
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-9955
  • Fax:
Mailing address:
  • Phone: 213-383-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA70290
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG15628
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG15628
License Number StateCA

VIII. Authorized Official

Name: DR. ARJANG NAIM
Title or Position: OWNER
Credential: M.D.
Phone: 213-383-9955