Healthcare Provider Details

I. General information

NPI: 1669533907
Provider Name (Legal Business Name): DOROTHY MAE MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 S BROADWAY
LOS ANGELES CA
90003-3635
US

IV. Provider business mailing address

PO BOX 5167
OCEANSIDE CA
92052-5167
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-1196
  • Fax: 323-750-0330
Mailing address:
  • Phone: 323-750-1196
  • Fax: 323-750-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA064610
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL JEROME SINGLETON
Title or Position: CEO
Credential: M.D.
Phone: 310-600-6046