Provider Demographics
NPI:1992140446
Name:IN HIS IMAGE FAMILY CLINIC, INC
Entity type:Organization
Organization Name:IN HIS IMAGE FAMILY CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MESHRIKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-718-0500
Mailing Address - Street 1:18251 ROSCOE BLVD
Mailing Address - Street 2:105
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4200
Mailing Address - Country:US
Mailing Address - Phone:818-718-0500
Mailing Address - Fax:818-718-0501
Practice Address - Street 1:18251 ROSCOE BLVD
Practice Address - Street 2:#105
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4200
Practice Address - Country:US
Practice Address - Phone:818-718-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty