La Community Care Medical
Family Medicine in Hawthorne, CA. Organization (NPI-2).
NPI number1801099486
StatusActive
Last updated in NPPESApr 14, 2017
Details
- NPI
- 1801099486
- Entity type
- Organization (NPI-2)
- Legal business name
- La Community Care Medical
- Organization subpart
- No
- Enumeration date
- Jun 8, 2007
- Last updated
- Apr 14, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | A053317 | CA | Yes |
| 207R00000X | Internal Medicine | A053317 | CA |
Other names
- La Community Care Medical Associates INC (Other Name)
Practice location
11633 Hawthorne Blvd Ste 103Hawthorne, CA 90250-2323
Phone 310-219-2929 · Fax 310-219-2940
Mailing address
11633 Hawthorne Blvd Ste 103Hawthorne, CA 90250-2323
Authorized official
Augustine Iluore
Medical Director
3102192929
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