MEDICARE: IDEAL HEALTH CARE AND MEDICAL

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	174400000X	Specialist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265470868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL HEALTH CARE AND MEDICAL

Provider Business Mailing Address
First Line	:	6245 DE LONGPRE AVE
Second Line	:	206
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-462-2271
Fax Number	:	323-785-1223

Provider Business Practice Location Address
First Line	:	6245 DE LONGPRE AVE
Second Line	:	206
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-462-2271
Fax Number	:	323-785-1223

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ARNEL JOAQUIN
Credential	:	M.D.
Telephone Number	:	323-462-2271

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/22/2014

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Directions to “IDEAL HEALTH CARE AND MEDICAL ” Practice Location

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