MEDICARE: JRHEEMD PROFESSIONAL CORPORATION

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A92345	CA

General Provider Information

NPI Number	:	1659432409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRHEEMD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	714-777-2469
Fax Number	:	310-329-0176

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	714-777-2469
Fax Number	:	714-917-4620

Authorized Official
Title or Position	:	BUSINESS BILLING MANAGER
Name	:	MRS. TERESA Y MILLIGAN
Credential	:
Telephone Number	:	714-777-2469

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/14/2023

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Directions to “JRHEEMD PROFESSIONAL CORPORATION ” Practice Location

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