Healthcare Provider Details

I. General information

NPI: 1386942977
Provider Name (Legal Business Name): BMC MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 S MAIN ST
LOS ANGELES CA
90061-1926
US

IV. Provider business mailing address

11126 S MAIN ST
LOS ANGELES CA
90061-1926
US

V. Phone/Fax

Practice location:
  • Phone: 323-779-8398
  • Fax:
Mailing address:
  • Phone: 323-779-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA46478
License Number StateCA

VIII. Authorized Official

Name: EMMANUEL AYODELE
Title or Position: CEO
Credential: MD
Phone: 323-779-8398