1922248764 NPI number — CIRCLE MEDICAL GROUP INC

Table of content: (NPI 1922248764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922248764 NPI number — CIRCLE MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIRCLE 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:
1922248764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 1511
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403-5400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-526-3150
Provider Business Mailing Address Fax Number:
310-593-2799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1511
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90403-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-526-3150
Provider Business Practice Location Address Fax Number:
310-593-2799
Provider Enumeration Date:
03/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SINEL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
562-868-0373

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471V0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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