Beth Medical Clinic

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

A46478 Issued in CA

Legal business name

BETH MEDICAL CLINIC

Practice address

11126 S Main St
Los Angeles, CA 90061-1926

Phone

(323) 779-8398

Fax

(323) 779-8493

NPI assigned

Dec 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Emmanuel A Ayodele, MD

Title

Medical Doctor

Phone

(323) 779-8398

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104984137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11126 S MAIN ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900611926",
            "telephone_number": "323-779-8398",
            "fax_number": "323-779-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11126 S MAIN ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900611926",
            "telephone_number": "323-779-8398",
            "fax_number": "323-779-8493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AYODELE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "323-779-8398",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "A46478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A464780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karolina Betancourt
• Lorenzo Betancourt
• Trinidad Betancourt
• Madison Betcher, MD
• Alexander Joaquin Betetta
• Dedra F Bethany-Fulcher, LCSW
• Bethel Eye Center Medical Corporation
• Bethel Los Angeles Community Development Corporation
• Bethesda Health Group, Inc.
• Christopher Scott Bethurum

• Legal Medicine in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Legal Medicine in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.