NPIMap

Organization Active NPI

Med-Pro Family Clinic, a Medical Corporation

  • Surgery Physician
  • Glendale, CA
National Provider Identifier
1972690899
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A36908 Issued in CA
Legal business name
MED-PRO FAMILY CLINIC, A MEDICAL CORPORATION
Practice address
221 E. Glenoaks Blvd.
130
Glendale, CA 91207
Phone
(818) 549-1713
Fax
(818) 549-1716
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Sayeeda Sultana, MDNPI 1497841258
Title
Medical Director
Phone
(310) 635-3800

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
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X A36908 CA Primary

Addresses

Primary practice location

221 E. Glenoaks Blvd.
130
Glendale, CA 91207

Mailing address

11017 S. Atlantic Ave.
1St Floor
Lynwood, CA 90262
Phone (310) 635-3800

Other identifiers 1

IdentifierTypeStateIssuer
GR0085430MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972690899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11017 S. ATLANTIC AVE.",
            "address_2": "1ST FLOOR",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "90262",
            "telephone_number": "310-635-3800",
            "fax_number": "310-635-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 E. GLENOAKS BLVD.",
            "address_2": "130",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91207",
            "telephone_number": "818-549-1713",
            "fax_number": "818-549-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-PRO FAMILY CLINIC, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULTANA",
        "authorized_official_first_name": "SAYEEDA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "310-635-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A36908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0085430",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.