Healthcare Provider Details

I. General information

NPI: 1356956692
Provider Name (Legal Business Name): GOOD NEIGHBOR CLINIC & URGENT CARE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W MANCHESTER AVE STE A
LOS ANGELES CA
90047-5436
US

IV. Provider business mailing address

1270 S ALFRED ST UNIT 1064
LOS ANGELES CA
90035-2506
US

V. Phone/Fax

Practice location:
  • Phone: 323-991-2300
  • Fax:
Mailing address:
  • Phone: 323-991-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SHANE SHEIBANI DAVIDSON
Title or Position: ADMINISTRATOR
Credential: MD MBA
Phone: 310-212-1500