MEDICARE: SANAVIDA MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208D00000X	General Practice Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1952686271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANAVIDA MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	987 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3038
Country	:	US
Telephone Number	:	323-234-6300
Fax Number	:	323-234-0100

Provider Business Practice Location Address
First Line	:	987 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3038
Country	:	US
Telephone Number	:	323-234-6300
Fax Number	:	323-234-0100

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEJANDRO L GONZALES
Credential	:	DO
Telephone Number	:	626-664-1279

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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Directions to “SANAVIDA MEDICAL GROUP, INC. ” Practice Location

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