1548574056 NPI number — LA FAMILIA MEDICAL GROUP, INC.

Table of content: (NPI 1548574056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548574056 NPI number — LA FAMILIA MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA FAMILIA 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:
1548574056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6433 WHITTIER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90022-4627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-724-6674
Provider Business Mailing Address Fax Number:
323-724-9926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6433 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-724-6674
Provider Business Practice Location Address Fax Number:
323-724-9926
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BLOCK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
323-724-6674

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G24174 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: G24174 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com