Healthcare Provider Details

I. General information

NPI: 1417251687
Provider Name (Legal Business Name): MEDI CURE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4131 S VERMONT AVE
LOS ANGELES CA
90037-1918
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR STE 417
LOS ANGELES CA
90008-3614
US

V. Phone/Fax

Practice location:
  • Phone: 323-839-9067
  • Fax: 323-295-1071
Mailing address:
  • Phone: 323-295-1136
  • Fax: 323-295-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190636AN
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPHINE C. KANNIKE-MARTINS
Title or Position: CEO/EXEC. DIRECTOR
Credential: PHD., RD
Phone: 323-295-1136