NPIMap

Organization Active NPI

Nueva Esperanza Healthcare Medical Clinic Inc.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1518236017
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A56426 Issued in CA
Legal business name
NUEVA ESPERANZA HEALTHCARE MEDICAL CLINIC INC.
Practice address
1704 W Manchester Ave
Suite 109
Los Angeles, CA 90047-3063
Phone
(323) 778-8485
Fax
(323) 778-4452
NPI assigned
Dec 29, 2011
Last updated
Oct 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Authorized official

Name
Amani A EldessoukyNPI 1528074044
Title
President
Phone
(562) 505-0134

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A56426 CA Primary

Addresses

Primary practice location

1704 W Manchester Ave
Suite 109
Los Angeles, CA 90047-3063

Mailing address

1704 W Manchester Ave
Suite 109
Los Angeles, CA 90047-3063
Phone (323) 778-8485

Other identifiers 1

IdentifierTypeStateIssuer
00A564260MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Amani Eldessouky MD Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the 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": "1325116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1518236017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 W MANCHESTER AVE",
            "address_2": "SUITE 109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900473063",
            "telephone_number": "323-778-8485",
            "fax_number": "323-778-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W MANCHESTER AVE",
            "address_2": "SUITE 109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900473063",
            "telephone_number": "323-778-8485",
            "fax_number": "323-778-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUEVA ESPERANZA HEALTHCARE MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-29",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "ELDESSOUKY",
        "authorized_official_first_name": "AMANI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-505-0134"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A56426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A564260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.