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General NPI Number Information
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NPI Number | 1386110732
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Entity Type | Organization
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Legal Business Name | LA CLINICA DE LOS ANGELES MEDICAL GROUP APC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 1021 W MARTIN LUTHER KING JR BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90037-1816
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Country | US
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Telephone | 213-744-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 2098 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90011-1235
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Country | US
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Telephone | 213-744-9494
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMAD YAGHI
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Credential | MD
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Telephone | 213-744-9494
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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 |
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License Number State |
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