| Venice Culver Marina Medical Group Inc | |
|
12212 W Washington Blvd Los Angeles CA 90066 | |
| (310) 391-5241 | |
| (310) 397-4324 |
| Full Name | Venice Culver Marina Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12212 W Washington Blvd, Los Angeles, California |
| Authorized Official Name and Position | Jay Tehrani (BILLING MANAGER) |
| Authorized Official Contact | 3106729000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Venice Culver Marina Medical Group Inc Po Box 24706 Los Angeles CA 90024 Ph: (310) 391-5241 | Venice Culver Marina Medical Group Inc 12212 W Washington Blvd Los Angeles CA 90066 Ph: (310) 391-5241 |
| NPI Number | 1376711440 |
|---|---|
| Provider Enumeration Date | 02/12/2008 |
| Last Update Date | 10/10/2017 |
| Medicare PECOS PAC ID | 7810923877 |
|---|---|
| Medicare Enrollment ID | O20050711000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376711440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | A32561 (California) | Primary |
| Provider Name | Soheil Hekmat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043358369 PECOS PAC ID: 7911957055 Enrollment ID: I20050126001171 |
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