Healthcare Provider Details

I. General information

NPI: 1396287082
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 PEYTON DR
CHINO HILLS CA
91709-6004
US

IV. Provider business mailing address

393 E WALNUT ST FL 3
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMIN DAVIDOFF
Title or Position: EXECUTIVE MEDICAL DIRECTOR
Credential:
Phone: 877-608-0044