MEDICARE: VERDUGO MULTI-SPECIALTY 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	208D00000X	General Practice Physician	A91884	CA

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	:	1487869533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERDUGO MULTI-SPECIALTY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	819 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	323-928-5052
Fax Number	:	323-274-4604

Provider Business Practice Location Address
First Line	:	819 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	323-928-5052
Fax Number	:	323-274-4604

Authorized Official
Title or Position	:	CEO
Name	:	ARAM MANOUKYAN
Credential	:
Telephone Number	:	323-255-5818

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	01/13/2016

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