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General NPI Number Information
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NPI Number | 1982588737
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Entity Type | Organization
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Legal Business Name | AERICKS MEDICAL CLINIC INC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 645 AERICK ST STE 2
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City | INGLEWOOD
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State | CA
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Zip | 90301-4883
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Country | US
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Telephone | 310-810-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 645 AERICK ST STE 2
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City | INGLEWOOD
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State | CA
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Zip | 90301-4883
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Country | US
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Telephone | 310-810-1058
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LEO MALLO JR.
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Credential | ETC
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Telephone | 310-736-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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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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