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General NPI Number Information
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NPI Number | 1962685966
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Entity Type | Organization
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Legal Business Name | TWEETY FAMILY CLINIC INC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 3050 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-5742
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Country | US
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Telephone | 323-357-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-5742
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Country | US
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Telephone | 323-357-0700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAGAIE LAMIE HAKIM
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Credential | M.D
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Telephone | 323-357-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A056354
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License Number State | CA
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