Healthcare Provider Details

I. General information

NPI: 1104742733
Provider Name (Legal Business Name): MDM RENEWCARE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W OLYMPIC BLVD APT 905
LOS ANGELES CA
90015-1451
US

IV. Provider business mailing address

501 W OLYMPIC BLVD APT 905
LOS ANGELES CA
90015-1451
US

V. Phone/Fax

Practice location:
  • Phone: 747-254-2855
  • Fax:
Mailing address:
  • Phone: 747-254-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAM ALAKA
Title or Position: CEO
Credential: MD
Phone: 747-254-2855