Provider Demographics
NPI:1720269194
Name:HEALTHCARE ANGELS MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:HEALTHCARE ANGELS MEDICAL CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:ELIAHOU
Authorized Official - Last Name:SEFARADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-592-2522
Mailing Address - Street 1:9146 SEPULVEDA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6948
Mailing Address - Country:US
Mailing Address - Phone:818-920-1133
Mailing Address - Fax:818-893-6030
Practice Address - Street 1:9146 SEPULVEDA BLVD STE B
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6948
Practice Address - Country:US
Practice Address - Phone:818-920-1133
Practice Address - Fax:818-893-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64183208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641830Medicaid
CAW17112OtherMEDICARE GROUP ID
CAW17112OtherMEDICARE GROUP ID