MEDICARE: PHYSICIANS AND SURGEONS HOME CARE INC

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	208600000X	Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA337916	OTHER	CA	MEDICARE NORTH CALIFORNIA
2	CB308648	OTHER	CA	MEDICARE SOUTH CALIFORNIA

General Provider Information

NPI Number	:	1184105231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS AND SURGEONS HOME CARE INC

Provider Business Mailing Address
First Line	:	955 CARRILLO DR STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5472
Country	:	US
Telephone Number	:	818-213-6325
Fax Number	:	818-532-1002

Provider Business Practice Location Address
First Line	:	955 CARRILLO DR STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5472
Country	:	US
Telephone Number	:	818-213-6325
Fax Number	:	818-532-1002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL JACOB GHODS
Credential	:
Telephone Number	:	424-258-0124

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	04/24/2026

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