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General NPI Number Information
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NPI Number | 1396235883
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Entity Type | Organization
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Legal Business Name | SAN JUDAS COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 2972 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-1101
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Country | US
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Telephone | 213-484-0000
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Fax | 213-387-0011
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Provider Business Mailing Address
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Address Line | 1080 N WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-2310
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Country | US
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Telephone | 213-484-0000
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Fax | 213-387-0011
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Authorized Official
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Title or Position | CEO
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Name | MR. NEJAT ROSTAMI
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Credential | M.D.
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Telephone | 310-780-4674
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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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