MEDICARE: MINORITY AIDS PROJECT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		CA

General Provider Information

NPI Number	:	1023135928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINORITY AIDS PROJECT

Provider Business Mailing Address
First Line	:	5149 W JEFFERSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3836
Country	:	US
Telephone Number	:	323-936-4949
Fax Number	:	323-936-2044

Provider Business Practice Location Address
First Line	:	5149 W JEFFERSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3836
Country	:	US
Telephone Number	:	323-936-4949
Fax Number	:	323-936-2044

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. VICTOR P MCKAMIE
Credential	:	MPA
Telephone Number	:	323-936-4949

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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