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General NPI Number Information
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NPI Number | 1356956692
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Entity Type | Organization
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Legal Business Name | GOOD NEIGHBOR CLINIC & URGENT CARE A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 1425 W MANCHESTER AVE STE A
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City | LOS ANGELES
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State | CA
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Zip | 90047-5436
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Country | US
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Telephone | 323-991-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 S ALFRED ST UNIT 1064
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City | LOS ANGELES
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State | CA
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Zip | 90035-2506
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Country | US
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Telephone | 323-991-2300
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DANIEL SHANE SHEIBANI DAVIDSON
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Credential | MD MBA
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Telephone | 310-212-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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