MEDICARE: AMERICAN CARDIOCARE MEDICAL CENTER 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	261QM1300X	Multi-Specialty Clinic/Center	FNP39403	CA

General Provider Information

NPI Number	:	1891039228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN CARDIOCARE MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	PO BOX 425
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-0425
Country	:	US
Telephone Number	:	562-591-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3911
Country	:	US
Telephone Number	:	562-591-9000
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JERRY A OKONKWOAGUOLU
Credential	:	M.D.
Telephone Number	:	310-490-2322

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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