| Southern California Specialty Care, Llc | |
|
845 N Lark Ellen Ave West Covina CA 91791 | |
| (626) 339-5451 | |
| (626) 967-3809 |
| Full Name | Southern California Specialty Care, Llc |
|---|---|
| Speciality | General Practice |
| Location | 845 N Lark Ellen Ave, West Covina, California |
| Authorized Official Name and Position | Mostafa Adam Darvish (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7148934541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Specialty Care, Llc 845 N Lark Ellen Ave West Covina CA 91791-1069 Ph: (626) 339-5451 | Southern California Specialty Care, Llc 845 N Lark Ellen Ave West Covina CA 91791 Ph: (626) 339-5451 |
| NPI Number | 1164654315 |
|---|---|
| Provider Enumeration Date | 08/20/2009 |
| Last Update Date | 07/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164654315 | NPI | - | NPPES |
| HSP32028F | Medicaid | CA | |
| 954494848 | Other | CA | TRICARE/CHAMPUS |
| ZZZB1900Z | Other | CA | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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