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General NPI Number Information
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NPI Number | 1760679856
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Entity Type | Organization
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Legal Business Name | SCCC A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 1510 S CENTRAL AVE SUITE 420
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City | GLENDALE
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State | CA
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Zip | 91204-2500
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Country | US
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Telephone | 818-242-8816
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Fax | 818-242-0610
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Provider Business Mailing Address
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Address Line | 1510 S CENTRAL AVE SUITE 420
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City | GLENDALE
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State | CA
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Zip | 91204-2500
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Country | US
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Telephone | 818-242-8816
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Fax | 818-242-0610
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Authorized Official
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Title or Position | HEALTH ADMINISTRATOR
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Name | MS. AYLIN I. HEMELIANS
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Credential | BS, MHA
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Telephone | 818-242-8816
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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 |
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License Number State |
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