MEDICARE: ALLERGY ASTHMA CARE 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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1891758751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY ASTHMA CARE CENTER, INC

Provider Business Mailing Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 630
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-393-1550
Fax Number	:	310-478-3601

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 630
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-393-1550
Fax Number	:	310-478-3601

Authorized Official
Title or Position	:	ASST MANAGER
Name	:	JESSICA DANESHRAD
Credential	:
Telephone Number	:	310-393-1550

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/05/2020

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