Hollywood Fountain Medical Group
Restricted
Hollywood Fountain Medical Group is subject to Restricted. See the individual lists below.
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Address
6234 Fountain Ave., Los Angeles, CA
ID Details
ID NUMBER : 00C188270GR0019100GR0012150
ID TYPE : provider_number
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Hollywood Fountain Medical Group Sanctioned By Below Authority
| List Name | List Authority | Effective Date ▼ | Status |
|---|---|---|---|
| The California Department of Health Care Services | Oct 31, 1985 | active |
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