MEDICARE: CENTRAL NEIGHBORHOOD 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	261QP2300X	Primary Care Clinic/Center	A21064	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	:	1841338688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL NEIGHBORHOOD MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	2707 S CENTRAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-5527
Country	:	US
Telephone Number	:	323-234-5000
Fax Number	:	323-231-3985

Provider Business Practice Location Address
First Line	:	2707 S CENTRAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-5527
Country	:	US
Telephone Number	:	323-234-5000
Fax Number	:	323-231-3985

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BASSETT H.L. BROWN
Credential	:	M.D
Telephone Number	:	323-234-5000

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	05/12/2009

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