MEDICARE: ST ANDREWS 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	174400000X	Specialist	A40329	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A40329	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1821142670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ANDREWS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	5520 SANTA MONICA BLVD
Second Line	:	SUITE 112
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2932
Country	:	US
Telephone Number	:	323-860-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 SANTA MONICA BLVD
Second Line	:	SUITE 112
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2932
Country	:	US
Telephone Number	:	323-860-9054
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ARTHUR VALLES
Credential	:	MD
Telephone Number	:	323-860-9054

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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Directions to “ST ANDREWS MEDICAL GROUP INC ” Practice Location

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