Healthcare Provider Details

I. General information

NPI: 1265470868
Provider Name (Legal Business Name): IDEAL HEALTH CARE AND MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NORTH VERMONT AVE, DOCTORS TOWER SUITE 601
LOS ANGELES CA
90027
US

IV. Provider business mailing address

1300 NORTH VERMONT AVE, DOCTORS TOWER SUITE 601
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 818-396-5670
  • Fax: 818-396-5672
Mailing address:
  • Phone: 818-396-5670
  • Fax: 818-396-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: ARNEL MONTELOYOLA JOAQUIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 213-880-3305