NPIMap

Organization Active NPI

MLT Kidane Physician Assistant Corporation

Doing business as Med-Hanit Alem Medical Clinic

  • Medical Physician Assistant
  • Moreno Valley, CA
National Provider Identifier
1225471956
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA20768 Issued in CA
Legal business name
MLT KIDANE PHYSICIAN ASSISTANT CORPORATION
Doing business as
Med-Hanit Alem Medical Clinic
Practice address
12981 Perris Blvd
Suite #101
Moreno Valley, CA 92553-4102
Phone
(951) 571-0632
Fax
(951) 571-4149
NPI assigned
Apr 11, 2013
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Ms. Meaza Z. Kidane, PANPI 1174853907
Title
President
Phone
(951) 571-0632

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA20768 CA Primary

Addresses

Primary practice location

12981 Perris Blvd
Suite #101
Moreno Valley, CA 92553-4102

Mailing address

12981 Perris Blvd
Suite #101
Moreno Valley, CA 92553-4102
Phone (951) 571-0632

Other names 1

  • Med-Hanit Alem Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1225471956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12981 PERRIS BLVD",
            "address_2": "SUITE #101",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534102",
            "telephone_number": "951-571-0632",
            "fax_number": "951-571-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12981 PERRIS BLVD",
            "address_2": "SUITE #101",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534102",
            "telephone_number": "951-571-0632",
            "fax_number": "951-571-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLT KIDANE PHYSICIAN ASSISTANT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "KIDANE",
        "authorized_official_first_name": "MEAZA",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-571-0632",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA20768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Med-Hanit Alem Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.