Healthcare Provider Details

I. General information

NPI: 1750704250
Provider Name (Legal Business Name): APOLLOMED CARE CLINIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3056 FLETCHER DR
LOS ANGELES CA
90065-2207
US

IV. Provider business mailing address

700 N BRAND BLVD SUITE 220
GLENDALE CA
91203-1247
US

V. Phone/Fax

Practice location:
  • Phone: 323-256-2231
  • Fax: 323-256-6211
Mailing address:
  • Phone: 818-839-5200
  • Fax: 818-839-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA69768
License Number StateCA

VIII. Authorized Official

Name: WARREN HOSSEINION
Title or Position: CEO
Credential: M.D.
Phone: 818-839-5200