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General NPI Number Information
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NPI Number | 1295078376
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH MEDICAL SERVICE
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1701 E MCFADDEN AVE UNIT D
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City | SANTA ANA
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State | CA
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Zip | 92705-4647
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Country | US
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Telephone | 323-298-1668
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90008-4902
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Country | US
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Telephone | 323-298-1668
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MELVIN SMITH
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Credential |
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Telephone | 951-695-9648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GM702A
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License Number State | CA
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