National Provider Identifier Database

SOUTHERN CALIFORNIA SPECIALTY CARE LLC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
845 N LARK ELLEN AVE
WEST COVINA, CA91791
Phone: 626-339-5451
Fax: 626-967-3809
Website:
Specialty Taxonomy Code
* General Practice 208D00000X

* Indicates primary specialty

NPI Profile & details for SOUTHERN CALIFORNIA SPECIALTY CARE, LLC

NPI Number 1164654315
Legal business name
LBN
SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Authorized official MOSTAFA DARVISH - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 08/20/2009
Last updated 07/23/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • CA Medicaid: HSP32028F
  • CA Other: ZZZB1900Z BLUE CROSS
  • CA Other: 954494848 TRICARE/CHAMPUS

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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