| Lebreoot A Professional Medical Corporation | |
|
1073 Ross Ave Ste D El Centro CA 92243-4371 | |
| (305) 310-8155 | |
| (713) 510-1548 |
| Full Name | Lebreoot A Professional Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1073 Ross Ave Ste D, El Centro, California |
| Authorized Official Name and Position | Joobin A Shemtov (CEO) |
| Authorized Official Contact | 3109997098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lebreoot A Professional Medical Corporation 9171 Wilshire Blvd Ste 526 Beverly Hills CA 90210-5530 Ph: (310) 999-7098 | Lebreoot A Professional Medical Corporation 1073 Ross Ave Ste D El Centro CA 92243-4371 Ph: (305) 310-8155 |
| NPI Number | 1083306773 |
|---|---|
| Provider Enumeration Date | 05/22/2023 |
| Last Update Date | 05/22/2023 |
| Medicare PECOS PAC ID | 4981068756 |
|---|---|
| Medicare Enrollment ID | O20230912002701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083306773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Maurice M Levy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285700492 PECOS PAC ID: 5991608887 Enrollment ID: I20080722000786 |
| Provider Name | Maria J Ordenana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063157352 PECOS PAC ID: 2365813912 Enrollment ID: I20230119000652 |
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