Clover Medical Corporation Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CLOVER MEDICAL CORPORATION INC

Practice address

12134 Victory Blvd
Suite C
North Hollywood, CA 91606-3205

Phone

(818) 762-8702

Fax

(818) 761-2583

NPI assigned

Dec 17, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Mitch Rubin

Title

President

Phone

(818) 762-8702

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1324080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464134400000",
    "number": "1326317595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12134 VICTORY BLVD",
            "address_2": "SUITE C",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063205",
            "telephone_number": "818-762-8702",
            "fax_number": "818-761-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12134 VICTORY BLVD",
            "address_2": "SUITE C",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063205",
            "telephone_number": "818-762-8702",
            "fax_number": "818-761-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER MEDICAL CORPORATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-17",
        "last_updated": "2016-05-25",
        "status": "A",
        "authorized_official_last_name": "RUBIN",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-762-8702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; 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.