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General NPI Number Information
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NPI Number | 1962797738
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Entity Type | Organization
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Legal Business Name | LIFE CARE MEDICAL CLINIC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 1211 N VERMONT AVE SUITE 207
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City | LOS ANGELES
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State | CA
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Zip | 90029-1748
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Country | US
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Telephone | 323-664-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 N VERMONT AVE SUITE 207
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City | LOS ANGELES
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State | CA
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Zip | 90029-1748
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Country | US
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Telephone | 323-664-4044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN LEONARD GOFF
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Credential | M.D.
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Telephone | 323-664-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | C30424
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C30424
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C30424
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License Number State | CA
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