Provider Demographics
NPI:1437959095
Name:DOCTOR'S MANAGED COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:DOCTOR'S MANAGED COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGASAMUDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASHOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-515-8804
Mailing Address - Street 1:851 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1047
Mailing Address - Country:US
Mailing Address - Phone:818-515-2309
Mailing Address - Fax:
Practice Address - Street 1:1520 N MOUNTAIN AVE STE 128
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1132
Practice Address - Country:US
Practice Address - Phone:909-949-9299
Practice Address - Fax:909-949-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health