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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 Specialty Code Provider Type

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
Indicates primary specialty

NPI Profile & details for SOUTHERN CALIFORNIA SPECIALTY CARE, LLC

NPI Number 1164654315
LBN Legal business name SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Authorized official MOSTAFA DARVISH - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 08/20/2009
Last updated 07/23/2018 - About 8 years ago
Identifiers
CA Medicaid HSP32028F
CA Other ZZZB1900Z BLUE CROSS
CA Other 954494848 TRICARE/CHAMPUS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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