St Nicholas Medical Group
Family Medicine in Los Angeles, CA. Organization (NPI-2).
NPI number1982808622
StatusActive
Last updated in NPPESFeb 8, 2010
Details
- NPI
- 1982808622
- Entity type
- Organization (NPI-2)
- Legal business name
- St Nicholas Medical Group
- Organization subpart
- No
- Enumeration date
- Jun 14, 2007
- Last updated
- Feb 8, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | A40329 | CA | Yes |
Practice location
5520 Santa Monica BlvdSuite 112
Los Angeles, CA 90038-2932
Phone 323-860-9054 · Fax 323-860-9053
Mailing address
5520 Santa Monica BlvdSuite 112
Los Angeles, CA 90038
Phone 323-860-9054 · Fax 323-860-9053
Authorized official
Lorenzo Esguerra Tizon
Medical Director
3238609054
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