1023425972 NPI number — SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

Table of content: ADAM MEYERS AGACNP, RNFA (NPI 1083021240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023425972 NPI number — SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
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:
6
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:
1023425972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
393 E WALNUT ST
Provider Second Line Business Mailing Address:
PROVIDER ENROLLMENT, 3RD FLOOR
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91188-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-608-0044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1288 CAMINO DEL RIO N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-608-0044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDOFF
Authorized Official First Name:
RAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE MEDICAL DIRECTOR
Authorized Official Telephone Number:
877-608-0044

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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