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General NPI Number Information
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NPI Number | 1538462908
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Entity Type | Organization
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Legal Business Name | MERIDIAN HEALTH SYSTEMS, P.C.
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 4127 W 62ND ST
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City | LOS ANGELES
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State | CA
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Zip | 90043-3612
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Country | US
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Telephone | 866-767-4832
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Fax | 310-693-8082
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Provider Business Mailing Address
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Address Line | 4127 W 62ND ST
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City | LOS ANGELES
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State | CA
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Zip | 90043-3612
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Country | US
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Telephone | 323-345-1176
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Fax | 310-693-8082
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANTHONY C DIKE
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Credential | M.D.
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Telephone | 323-345-1176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A43519
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License Number State | CA
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