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EAGLE ROCK MEDICAL CENTER
NPI 1972283760
Family Medicine in Los Angeles, CA

Active since July 18, 2023CLIA 05D2291996 · Waiver
4867 EAGLE ROCK BLVD STE 1, LOS ANGELES, CA 90041(323) 254-6754(323) 257-5949 Get Directions Write a Review

NPPES record last updated: July 25, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 25, 2023, Jul 18, 2023 (2 updates tracked since 2023).

About Eagle Rock Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAGLE ROCK MEDICAL CENTER (NPI 1972283760) is a healthcare organization registered as a family medicine in Los Angeles, California and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through October 17, 2027 and lists Ayuna Panossian, Owner, as its authorized official.

NPPES Registry Identity

NPI1972283760
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEAGLE ROCK MEDICAL CENTER
Location Address4867 EAGLE ROCK BLVD STE 1Los Angeles, CA 90041-2649
Mailing Address4867 Eagle Rock Blvd Ste 1Los Angeles, CA 90041-2649 · (323) 254-6754 · Fax (323) 257-5949
Phone(323) 254-6754
Fax(323) 257-5949
Organization SubpartNo
Authorized OfficialAyuna PanossianOwner · (323) 254-6754
Enumeration DateJuly 18, 2023
Last NPPES UpdateJuly 25, 20232 updates tracked since enumeration
NPPES CertifiedJuly 25, 2023
✔ NPI 1972283760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4867 EAGLE ROCK BLVD STE 1, Los Angeles, CA 90041
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2291996

Eagle Rock Medical Center · Los Angeles, CA
Active · expires Oct 17, 2027
CLIA Number05D2291996
Laboratory TypePhysician Office
Certificate Effective DateOctober 18, 2025
Certificate Expiration DateOctober 17, 2027
Laboratory DirectorAyuna Panossian
Laboratory Phone(818) 395-2248
Laboratory LocationEagle Rock Medical Center4867 Eagle Rock Blvd Suite 1, Los Angeles, CA 90041
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eagle Rock Medical Center's NPI number?

The NPI number for Eagle Rock Medical Center is 1972283760. It was assigned to this organization in the NPPES registry on July 18, 2023.

Where is Eagle Rock Medical Center located?

Eagle Rock Medical Center is located at 4867 Eagle Rock Blvd Ste 1, Los Angeles, CA 90041. The listed phone number is (323) 254-6754.

What is Eagle Rock Medical Center's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Eagle Rock Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2291996) is associated with this NPI, valid through October 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Eagle Rock Medical Center was last updated on July 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.