Healthcare Provider Details

I. General information

NPI: 1528431046
Provider Name (Legal Business Name): CAREMORE HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 EAST 1ST STREET
LOS ANGELES CA
90063
US

IV. Provider business mailing address

3513 EAST 1ST STREET
LOS ANGELES CA
90063
US

V. Phone/Fax

Practice location:
  • Phone: 323-859-2660
  • Fax:
Mailing address:
  • Phone: 323-859-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20A11018
License Number StateCA

VIII. Authorized Official

Name: ROBIN A HATAM
Title or Position: MD
Credential:
Phone: 323-859-2660