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General NPI Number Information
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NPI Number | 1124208087
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Entity Type | Organization
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Legal Business Name | AUTUMN MEDICAL CLINIC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 9200 COLIMA RD SUITE 207
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City | WHITTIER
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State | CA
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Zip | 90605-1814
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Country | US
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Telephone | 562-945-0252
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Fax | 562-945-0901
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Provider Business Mailing Address
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Address Line | 9200 COLIMA RD SUITE 207
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City | WHITTIER
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State | CA
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Zip | 90605-1814
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Country | US
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Telephone | 562-945-0252
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Fax | 562-945-0901
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Authorized Official
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Title or Position | CEO
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Name | DR. MEHRUNISA MOHAMMEDI
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Credential | M.D.
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Telephone | 562-945-0252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A25926
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A84718
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License Number State | CA
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