| Wesley Health Centers Vermont Annex | |
|
964 N Vermont Ave Los Angeles CA 90029-3529 | |
| (323) 201-4516 | |
| Not Available |
| Full Name | Wesley Health Centers Vermont Annex |
|---|---|
| Speciality | Clinic/Center |
| Location | 964 N Vermont Ave, Los Angeles, California |
| Authorized Official Name and Position | Alvaro Prospero Ballesteros (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3232014516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wesley Health Centers Vermont Annex 5650 Jillson St Commerce CA 90040-1482 Ph: (323) 201-4516 | Wesley Health Centers Vermont Annex 964 N Vermont Ave Los Angeles CA 90029-3529 Ph: (323) 201-4516 |
| NPI Number | 1649896903 |
|---|---|
| Provider Enumeration Date | 06/23/2020 |
| Last Update Date | 06/25/2020 |
| Medicare PECOS PAC ID | 1850394123 |
|---|---|
| Medicare Enrollment ID | O20200722001441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649896903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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