MEDICARE: BIENVENIDOS CHILDRENS CENTER

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	208D00000X	General Practice Physician	A63662	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

General Provider Information

NPI Number	:	1568674398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIENVENIDOS CHILDRENS CENTER

Provider Business Mailing Address
First Line	:	5257 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2020
Country	:	US
Telephone Number	:	323-726-9790
Fax Number	:	323-726-9789

Provider Business Practice Location Address
First Line	:	5257 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2020
Country	:	US
Telephone Number	:	323-726-9790
Fax Number	:	323-726-9789

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GEORGE MORAN
Credential	:	MD
Telephone Number	:	323-726-9790

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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