| Community Care Medical Center Inc. | |
|
13118 Sherman Way North Hollywood CA 91605 | |
| (818) 308-6318 | |
| (818) 308-6373 |
| Full Name | Community Care Medical Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 13118 Sherman Way, North Hollywood, California |
| Authorized Official Name and Position | Wendi M. Rodriguez (CEO/ADMINISTRATOR) |
| Authorized Official Contact | 8183086318 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Medical Center Inc. 13118 Sherman Way North Hollywood CA 91605 Ph: (818) 308-6318 | Community Care Medical Center Inc. 13118 Sherman Way North Hollywood CA 91605 Ph: (818) 308-6318 |
| NPI Number | 1265093520 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 05/06/2021 |
| Medicare PECOS PAC ID | 9133557010 |
|---|---|
| Medicare Enrollment ID | O20200309001413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265093520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Camellia Babaie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902175441 PECOS PAC ID: 4688816374 Enrollment ID: I20130808000594 |
| Provider Name | Jamie Moises |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598402943 PECOS PAC ID: 1153706775 Enrollment ID: I20220919001553 |
| Provider Name | Halima Bassam Azim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184396822 PECOS PAC ID: 6103260617 Enrollment ID: I20240222003096 |
| Provider Name | Olga B Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225748791 PECOS PAC ID: 0244686871 Enrollment ID: I20240405002571 |
| Provider Name | Candida Montero Varela |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467219048 PECOS PAC ID: 2365976966 Enrollment ID: I20241105001285 |
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