Healthcare Provider Details

I. General information

NPI: 1518729219
Provider Name (Legal Business Name): MEDACCESS COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10823 OXNARD ST
NORTH HOLLYWOOD CA
91606-5020
US

IV. Provider business mailing address

2629 N KEYSTONE ST
BURBANK CA
91504-2113
US

V. Phone/Fax

Practice location:
  • Phone: 818-426-0810
  • Fax: 818-450-0451
Mailing address:
  • Phone: 818-426-0810
  • Fax: 818-450-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOUSHEG EBRAHIMIAN
Title or Position: CEO
Credential: PHARMD
Phone: 818-426-0810