| Pipeline Community Specialty Clinic | |
|
1141 W Redondo Beach Blvd Ste 212 Gardena CA 90247-3584 | |
| (310) 698-5463 | |
| Not Available |
| Full Name | Pipeline Community Specialty Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1141 W Redondo Beach Blvd Ste 212, Gardena, California |
| Authorized Official Name and Position | Vincent Green (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3103210143 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pipeline Community Specialty Clinic Po Box 80717 City Of Industry CA 91716-8416 Ph: (310) 321-0143 | Pipeline Community Specialty Clinic 1141 W Redondo Beach Blvd Ste 212 Gardena CA 90247-3584 Ph: (310) 698-5463 |
| NPI Number | 1053082586 |
|---|---|
| Provider Enumeration Date | 09/23/2021 |
| Last Update Date | 01/25/2023 |
| Medicare PECOS PAC ID | 6204203573 |
|---|---|
| Medicare Enrollment ID | O20221031001878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053082586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Vincent W Green |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902849862 PECOS PAC ID: 0941296875 Enrollment ID: I20040426001421 |
| Provider Name | Isabelle Marie Mckay |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992200638 PECOS PAC ID: 4385998913 Enrollment ID: I20221128001910 |
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