Maywood Family Medical Center
Organization Active NPI Clinic/Center · Maywood, CA
NPI 1801184841 · NPPES record last updated Jul 12, 2011
Key facts
- NPI
- 1801184841
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- A45155 (CA)
- Legal business name
- MAYWOOD FAMILY MEDICAL CENTER
- Practice address
- 5920 Atlantic Blvd
Maywood, CA 90270-3101 - Phone
- (323) 562-2535
- Fax
- (323) 562-2558
- NPI assigned
- Jul 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Ragaa Z. Iskarous, M.D.
- Title
- Chief Executive Officer
- Phone
- (562) 522-7413
Practitioners 1
-
Ragaa Iskarous, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0966981 | Maywood Family Medical Center | Certificate of waiver | Oct 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120111000381 | CA | Part B Supplier - Clinic/Group Practice | 4587831797 |
Receives reassigned benefits from 1 practitioner Practice locations: Maywood, CA |
National Provider Directory
Locations
5920 Atlantic Blvd
Maywood, CA 90270
Phone (323) 562-2535
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | A45155 | CA | Yes |
Addresses
Primary practice location
5920 Atlantic Blvd
Maywood, CA 90270-3101
Mailing address
5920 Atlantic Blvd
Maywood, CA 90270-3101
Phone (323) 562-2535
Other providers in Maywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.