MEDICARE: LPI MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1033979489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LPI MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	7514 GIRARD AVE # 1605
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-5149
Country	:	US
Telephone Number	:	858-375-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 LA JOLLA VILLAGE DR STE 340
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4626
Country	:	US
Telephone Number	:	858-375-6152
Fax Number	:	833-449-4008

Authorized Official
Title or Position	:	CFO
Name	:	DAVID BRICKEN
Credential	:
Telephone Number	:	936-827-8502

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/22/2024

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