Healthcare Provider Details

I. General information

NPI: 1023356706
Provider Name (Legal Business Name): HAYIM TOVIM 2 ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 S FAIRFAX AVE
LOS ANGELES CA
90019-4402
US

IV. Provider business mailing address

1061 S FAIRFAX AVE
LOS ANGELES CA
90019-4402
US

V. Phone/Fax

Practice location:
  • Phone: 310-420-4449
  • Fax:
Mailing address:
  • Phone: 310-420-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0600001833
License Number StateCA

VIII. Authorized Official

Name: MR. DANIEL SABZEROU
Title or Position: OWNER
Credential:
Phone: 310-420-4449