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General NPI Number Information
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NPI Number | 1205353760
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Entity Type | Organization
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Legal Business Name | ALL CARE ONE COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 7300 SANTA FE AVENUE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 323-277-8900
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Fax | 323-277-8902
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Provider Business Mailing Address
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Address Line | 7300 SANTA FE AVENUE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 323-277-8900
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Fax | 323-277-8902
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Authorized Official
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Title or Position | CFO
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Name | MR. MICHAEL KONONENKO
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Credential |
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Telephone | 323-277-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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