Southern California Permanente Medical Group
Health Maintenance Organization in Los Angeles, CA. Organization (NPI-2).
NPI number1043242563
StatusActive
Last updated in NPPESNov 2, 2021
Details
- NPI
- 1043242563
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern California Permanente Medical Group
- Organization subpart
- No
- Enumeration date
- Jul 7, 2006
- Certification date
- Nov 2, 2021
- Last updated
- Nov 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302R00000X | Health Maintenance Organization | – | – | Yes |
Practice location
6041 Cadillac AveLos Angeles, CA 90034-1702
Phone 323-857-2000
Mailing address
393 E Walnut St3rd Fl Phr Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone 626-405-7914 · Fax 626-405-4600
Authorized official
Ramin Davidoff
Executive Medical Director
8776080044
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All 47 Health Maintenance Organization providers in Los Angeles · All 84,021 providers in Los Angeles
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