1275648735 NPI number — LOS ANGELES PM & R MEDICAL GROUP INC

Table of content: (NPI 1275648735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275648735 NPI number — LOS ANGELES PM & R MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES PM & R MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275648735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 E GREEN ST
Provider Second Line Business Mailing Address:
SUITE 254
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-304-9060
Provider Business Mailing Address Fax Number:
626-304-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 W HUNTINGTON DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-3490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-304-9060
Provider Business Practice Location Address Fax Number:
626-304-9010
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRITTON
Authorized Official First Name:
LIVA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
626-304-9060

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com