=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841456019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELES CLINIC AND RESEARCH INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2008
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11818 WILSHIRE BLVD SUITE 200
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-6646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-231-2121
-----------------------------------------------------
Fax | 310-231-2199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11800 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-231-2121
-----------------------------------------------------
Fax | 310-231-2199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOC. DIRECTOR OF PHARMACY SERVICE
-----------------------------------------------------
Name | DR. NANAZ AMINI
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 310-231-2180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------