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General NPI Number Information
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NPI Number | 1326317595
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Entity Type | Organization
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Legal Business Name | CLOVER MEDICAL CORPORATION INC
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Dates
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Enumeration Date | 12/17/2011
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 12134 VICTORY BLVD SUITE C
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3205
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Country | US
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Telephone | 818-762-8702
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Fax | 818-761-2583
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Provider Business Mailing Address
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Address Line | 12134 VICTORY BLVD SUITE C
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3205
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Country | US
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Telephone | 818-762-8702
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Fax | 818-761-2583
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MITCH RUBIN
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Credential |
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Telephone | 818-762-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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