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General NPI Number Information
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NPI Number | 1760698740
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Entity Type | Organization
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Legal Business Name | ALL FAMILY NEIGHBORHOOD MEDICAL CLINIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 874 W MARTIN LUTHER KING JR BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90037-1205
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Country | US
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Telephone | 323-238-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 1379 W PARK WESTERN DR SUITE 322
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City | SAN PEDRO
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State | CA
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Zip | 90732-2217
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Country | US
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Telephone | 323-238-0800
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Fax | 323-238-0875
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Authorized Official
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Title or Position | OWNER
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Name | MS. TERRI M. HANNAH
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Credential |
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Telephone | 323-238-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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