Healthcare Provider Details

I. General information

NPI: 1689961302
Provider Name (Legal Business Name): PEOPLE'S COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 VERDUGO RD SUITE A
LOS ANGELES CA
90065-3820
US

IV. Provider business mailing address

4139 VERDUGO RD SUITE A
LOS ANGELES CA
90065-3820
US

V. Phone/Fax

Practice location:
  • Phone: 323-928-5086
  • Fax: 323-274-4604
Mailing address:
  • Phone: 323-928-5086
  • Fax: 323-274-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: HOURY KARABIBERJIAN
Title or Position: HR DIRECTOR / ADMIN
Credential:
Phone: 323-928-5052