Healthcare Provider Details

I. General information

NPI: 1275648735
Provider Name (Legal Business Name): LOS ANGELES PM & R MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 201
ARCADIA CA
91007-3490
US

IV. Provider business mailing address

960 E GREEN ST SUITE 254
PASADENA CA
91106-2412
US

V. Phone/Fax

Practice location:
  • Phone: 626-304-9060
  • Fax: 626-304-9010
Mailing address:
  • Phone: 626-304-9060
  • Fax: 626-304-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LIVA GRITTON
Title or Position: SECRETARY
Credential:
Phone: 626-304-9060