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General NPI Number Information
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NPI Number | 1790908259
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Entity Type | Organization
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Legal Business Name | KAMILA COMPREHENSIVE HEALTH CENTER, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5831 FIRESTONE BLVD STE E
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City | SOUTH GATE
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State | CA
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Zip | 90280-3718
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Country | US
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Telephone | 562-806-7545
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Fax | 562-806-6062
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Provider Business Mailing Address
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Address Line | 5831 FIRESTONE BLVD STE E
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City | SOUTH GATE
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State | CA
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Zip | 90280-3718
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Country | US
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Telephone | 562-806-7545
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Fax | 562-806-6062
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. TIEN-HOANG LU MAI
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Credential | P.A.
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Telephone | 562-806-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA18238
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License Number State | CA
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