Healthcare Provider Details

I. General information

NPI: 1396166971
Provider Name (Legal Business Name): ST. JOSEPH HOSPITALIST MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 80660
CITY OF INDUSTRY CA
91716-8414
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax:
Mailing address:
  • Phone: 310-698-5452
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK R. BELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-698-5452