Edgemont Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A10630 Issued in CA

Legal business name

EDGEMONT MEDICAL CLINIC

Practice address

4864 Santa Monica Blvd
Los Angeles, CA 90029-2634

Phone

(818) 504-7265

Fax

(818) 504-1623

NPI assigned

Jun 11, 2014

Organization subpart

No

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

Authorized official

Name

Antonio Zamorano, D.O.

Title

President

Phone

(818) 504-7265

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Edgemont Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Arbi Ayvazian

  • Emergency Medicine Physician
  • Colton, CA
  • NPI 1336409291
  Medicare reassignment NPD
• Manuk Mike Chulyan, P.A.

  • Medical Physician Assistant
  • Glendale, CA
  • NPI 1881986826
  Medicare reassignment
• Andreh Carapiet, M.D.

  • Internal Medicine Physician
  • Glendale, CA
  • NPI 1649520909

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1588078166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4864 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900292634",
            "telephone_number": "818-504-7265",
            "fax_number": "818-504-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4864 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900292634",
            "telephone_number": "818-504-7265",
            "fax_number": "818-504-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEMONT MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "ZAMORANO",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-504-7265",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A10630",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A10630",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1043482060",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1881986826",
            "identifier": "1881986826",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgemont Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce Edgar, MD
• Edgardo M Capitulo MD Inc
• Juliet Beni Edgcomb, MD PHD
• Isabel Edge, M.D.
• Lindsey Edgell, OTR/L
• Edgemont Medical Equipment Inc.
• Bradford W. Edgerton, MD
• Grace Uwaila Ediae, MSC, CGC, CCGC
• Lara Kristin Edinger, DO
• Edio Corporation

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, 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 Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.