MEDICARE: JML MEDICAL GROUP INC

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	261QF0050X	Non-Surgical Family Planning Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275278608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JML MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4200 PECK RD STE B
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-673-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2208
Country	:	US
Telephone Number	:	626-673-5439
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EDDIE LARES
Credential	:	MD
Telephone Number	:	626-673-5439

Provider Enumeration Date	:	04/29/2022
Last Update Date	:	10/29/2024

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