=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679981872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW CARE CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2014
-----------------------------------------------------
Last Update Date | 07/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8740 S SEPULVEDA BLVD #160
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-645-2273
-----------------------------------------------------
Fax | 310-645-2274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8740 S SEPULVEDA BLVD #160
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-645-2273
-----------------------------------------------------
Fax | 310-645-2274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/OWNER
-----------------------------------------------------
Name | MRS. JOSEPH N MIKHAIL
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 310-645-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------