Healthcare Provider Details

I. General information

NPI: 1053826263
Provider Name (Legal Business Name): LARCHMONT MEDICAL CENTER AND URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LARCHMONT BLVD STE 404
LOS ANGELES CA
90004-6404
US

IV. Provider business mailing address

1030 S GLENDALE AVE STE 200
GLENDALE CA
91205-2866
US

V. Phone/Fax

Practice location:
  • Phone: 818-850-5667
  • Fax: 818-839-2303
Mailing address:
  • Phone: 818-850-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10630
License Number StateCA

VIII. Authorized Official

Name: ANTONIO ZAMORANO
Title or Position: CEO
Credential: D.O.
Phone: 818-850-5667