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General NPI Number Information
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NPI Number | 1912438516
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Entity Type | Organization
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Legal Business Name | FATIMA MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 3700 WILSHIRE BLVD SUITE 422
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City | LOS ANGELES
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State | CA
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Zip | 90010-2901
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Country | US
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Telephone | 310-674-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 4508 W IMPERIAL HWY
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City | INGLEWOOD
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State | CA
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Zip | 90304-2710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACOB EDEM
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Credential |
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Telephone | 213-718-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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