Healthcare Provider Details

I. General information

NPI: 1740958099
Provider Name (Legal Business Name): HOOVER CLINICA URGENCIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S HOOVER ST STE B
LOS ANGELES CA
90006-4910
US

IV. Provider business mailing address

1620 S HOOVER ST STE B
LOS ANGELES CA
90006-4910
US

V. Phone/Fax

Practice location:
  • Phone: 213-275-1314
  • Fax: 213-275-1456
Mailing address:
  • Phone: 213-275-1314
  • Fax: 213-275-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMIRA JAVAHERIFAR
Title or Position: VICE PRESIDENT
Credential: NP
Phone: 818-321-8486