1588862122 NPI number — EDWARD J. MCPHERSON MD A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1588862122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588862122 NPI number — EDWARD J. MCPHERSON MD A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J. MCPHERSON MD A PROFESSIONAL MEDICAL CORPORATION
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:
1588862122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17525 VENTURA BLVD
Provider Second Line Business Mailing Address:
203
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-986-0200
Provider Business Mailing Address Fax Number:
818-986-4393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S ALVARDO
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-745-8383
Provider Business Practice Location Address Fax Number:
213-745-8590
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERSON
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
213-742-6400

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G65157 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G65157 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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