Angeles Comprehensive Community Clinic, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

550000708 Issued in CA

Legal business name

ANGELES COMPREHENSIVE COMMUNITY CLINIC, INC.

Practice address

3920 Eagle Rock Blvd.
Suite a
Los Angeles, CA 90065-3606

Phone

(323) 255-5225

Fax

(323) 255-5229

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Liana Kazarova

Title

Administrator

Phone

(323) 255-5225

Specialties & licenses 1

Addresses

Other identifiers 13

Locations

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1457470684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 EAGLE ROCK BLVD.",
            "address_2": "SUITE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900653606",
            "telephone_number": "323-255-5225",
            "fax_number": "323-255-5229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 EAGLE ROCK BLVD.",
            "address_2": "SUITE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900653606",
            "telephone_number": "323-255-5225",
            "fax_number": "323-255-5229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELES COMPREHENSIVE COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "KAZAROVA",
        "authorized_official_first_name": "LIANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-255-5225",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "550000708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "OXG182",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ552884",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1326349960",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILY ENROLLMENT ENTITY",
            "identifier": "91355",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CB217375",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457470684",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA CARE",
            "identifier": "G56432MM2",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427355981",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8370190013",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811043474",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "OO3991",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427003300",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE 1ST",
            "identifier": "G56432F11",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Fedonenko, DDS, Apc
• Angela K Wallace, MFT
• Angela M. Franco, Physician Assistant, Inc.
• Angeleno Hospice, Inc.
• Angeles Clinic and Research Institute Inc
• Angeles Home Health Care, Inc.
• Angeles Medical Clinic, Inc.
• Angeles Psychology Group
• Angeles Psychology Group, a Professional Psychology Corporation
• Nancy Jazmin Angeles-Lopez

• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; 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.