Provider Demographics
NPI:1215109095
Name:DRMC-WESTERN OMM CLINIC OF DOWNEY LLC
Entity type:Organization
Organization Name:DRMC-WESTERN OMM CLINIC OF DOWNEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-904-5187
Mailing Address - Street 1:11500 BROOKSHIRE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-904-5187
Mailing Address - Fax:
Practice Address - Street 1:11411 BROOKSHIRE AVENUE
Practice Address - Street 2:SUITE #304
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-904-5187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DCH HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center