1790232551 NPI number — MEH HEALTH MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790232551 NPI number — MEH HEALTH MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEH HEALTH MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790232551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-3880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-933-5763
Provider Business Mailing Address Fax Number:
323-933-5273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12055 LAKEWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-869-4038
Provider Business Practice Location Address Fax Number:
562-923-0758
Provider Enumeration Date:
09/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HENDELES
Authorized Official First Name:
MOISE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
323-933-5763

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  197606651 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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