Active NPI
Aliso Medical Clinic, Inc
- General Practice Physician
- Los Angeles, CA
National Provider Identifier
1154457745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- A28934
- Legal business name
- ALISO MEDICAL CLINIC, INC
- Practice address
- 1625 E 4TH St
Los Angeles, CA 90033-4201 - Phone
- (323) 268-8391
- Fax
- (323) 268-8014
- NPI assigned
- Feb 26, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Christine Barnes-Keith
- Title
- Administrator
- Phone
- (323) 268-8391
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | A28934 | CA | Primary |
Addresses
Primary practice location
1625 E 4TH St
Los Angeles, CA 90033-4201
Mailing address
1625 E 4TH St
Los Angeles, CA 90033-4201
Phone (323) 268-8391
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ74805Z | Other | CA | BLUE SHIELD GRP PIN |
| GR0067720 | Medicaid | CA | |
| 00A289340 | Medicaid | CA | |
| 11513273 | Other | CA | CAQH ID |
National Provider Directory
National Provider DirectoryLocations
1625 E 4th St
Los Angeles, CA 90033
Phone (323) 268-8391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1154457745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 E 4TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900334201",
"telephone_number": "323-268-8391",
"fax_number": "323-268-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 E 4TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900334201",
"telephone_number": "323-268-8391",
"fax_number": "323-268-8014"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALISO MEDICAL CLINIC, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-26",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BARNES-KEITH",
"authorized_official_first_name": "CHRISTINE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "323-268-8391",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "General Practice",
"state": "CA",
"license": "A28934",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD GRP PIN",
"identifier": "ZZZ74805Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0067720",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A289340",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID",
"identifier": "11513273",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- 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.