| Peyman Banooni Medical Group Inc. | |
|
6120 Seville Ave Unit B Huntington Park CA 90255-2911 | |
| (323) 588-8855 | |
| (323) 587-5474 |
| Full Name | Peyman Banooni Medical Group Inc. |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 6120 Seville Ave, Huntington Park, California |
| Authorized Official Name and Position | Peyman Banooni (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3235888855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peyman Banooni Medical Group Inc. 269 S Beverly Dr 468 Beverly Hills CA 90212-3851 Ph: (323) 588-8855 | Peyman Banooni Medical Group Inc. 6120 Seville Ave Unit B Huntington Park CA 90255-2911 Ph: (323) 588-8855 |
| NPI Number | 1093128688 |
|---|---|
| Provider Enumeration Date | 06/11/2014 |
| Last Update Date | 06/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093128688 | NPI | - | NPPES |
| 00A750801 | Medicaid | CA | |
| 1811002777 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A75080 (California) | Secondary |
| 207V00000X | Obstetrics & Gynecology | A75080 (California) | Primary |
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