=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487832655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCAL HEALTHNET INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2008
-----------------------------------------------------
Last Update Date | 03/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5912 SANTA MONICA BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90038-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-461-3888
-----------------------------------------------------
Fax | 323-461-3250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5912 SANTA MONICA BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90038-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-461-3888
-----------------------------------------------------
Fax | 323-461-3250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | NABIL F KHALIL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-461-3888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | GR008540
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------