=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629573340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLES COMMUNITY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2018
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4626 N GRAND AVE
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91724-2055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-928-5052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4139 VERDUGO RD # A
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-928-5052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HR DIRECTOR
-----------------------------------------------------
Name | MRS. HOURY KARABIBERJIAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 323-928-5052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------