ALISO MEDICAL CLINIC INC NPI 1154457745

NPI Information

NPI: 1154457745
Provider Name: ALISO MEDICAL CLINIC, INC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
1625 E 4TH ST
LOS ANGELES, CA
ZIP 90033
Phone: (323) 268-8391
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ALISO MEDICAL CLINIC, INC is a general practice in Los Angeles, CA. ALISO MEDICAL CLINIC, INC NPI is 1154457745. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1625 E 4TH ST
LOS ANGELES, CA
ZIP 90033-201
Phone: (323) 268-8391
Fax: (323) 268-8014

The provider's authorized official is Christine Barnes-keith .
The authorized official title is Administrator and has the following contact phone number (323) 268-8391.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		A28934	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00A289340	MEDICAID	CALIFORNIA
2	GR0067720	MEDICAID	CALIFORNIA
3	ZZZ74805Z	OTHER	CALIFORNIA	BLUE SHIELD GRP PIN
4	11513273	OTHER	CALIFORNIA	CAQH ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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