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NPI Code Detail

MEDICARE: LOS ANGELES RENAISSANCE PROJECT

MEDICARE: LOS ANGELES RENAISSANCE PROJECT
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
1253Z00000XIn Home Supportive Care Agency
2332B00000XDurable Medical Equipment & Medical Supplies
3343900000XNon-emergency Medical Transport (VAN)
4390200000XStudent in an Organized Health Care Education/Training Program
5208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1477255222
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOS ANGELES RENAISSANCE PROJECT
Provider Business Mailing Address
First Line : 1216 W MADDOX ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-2241
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1216 W MADDOX ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-2241
Country : US
Telephone Number : 562-578-9290
Fax Number :
Authorized Official
Title or Position : CEO/FOUNDER
Name : MARCHAEL GORDON
Credential :
Telephone Number : 562-578-9290
Provider Enumeration Date : 03/17/2023
Last Update Date : 05/20/2023

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Directions to “LOS ANGELES RENAISSANCE PROJECT ” Practice Location

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