| Joshua Jordan Medical Corporation | |
|
3275 Tweedy Blvd South Gate CA 90280-4348 | |
| (714) 262-5136 | |
| (310) 499-5261 |
| Full Name | Joshua Jordan Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 3275 Tweedy Blvd, South Gate, California |
| Authorized Official Name and Position | Roya Masoud (PRESIDENT) |
| Authorized Official Contact | 7142625136 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joshua Jordan Medical Corporation Po Box 27851 Anaheim CA 92809-0128 Ph: (714) 262-5136 | Joshua Jordan Medical Corporation 3275 Tweedy Blvd South Gate CA 90280-4348 Ph: (714) 262-5136 |
| NPI Number | 1295034395 |
|---|---|
| Provider Enumeration Date | 03/15/2011 |
| Last Update Date | 06/27/2011 |
| Medicare PECOS PAC ID | 2961680624 |
|---|---|
| Medicare Enrollment ID | O20110628000360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295034395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20A10231 (California) | Primary |
| Provider Name | Roya Masoud |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295926087 PECOS PAC ID: 9436292711 Enrollment ID: I20100209000421 |
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