| Meyer Outreach Van | |
|
604 Rose Ave Venice CA 90291-2767 | |
| (310) 392-8630 | |
| Not Available |
| Full Name | Meyer Outreach Van |
|---|---|
| Speciality | Clinic/Center |
| Location | 604 Rose Ave, Venice, California |
| Authorized Official Name and Position | Mitesh G Popat (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3106647901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meyer Outreach Van 604 Rose Ave Venice CA 90291-2767 Ph: (310) 392-8630 | Meyer Outreach Van 604 Rose Ave Venice CA 90291-2767 Ph: (310) 392-8630 |
| NPI Number | 1326704107 |
|---|---|
| Provider Enumeration Date | 11/16/2021 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Medicare PECOS PAC ID | 2264339126 |
|---|---|
| Medicare Enrollment ID | O20250623003316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326704107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
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