Healthcare Provider Details

I. General information

NPI: 1528114691
Provider Name (Legal Business Name): RICHARD B JURMAIN MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE SUITE 704
CULVER CITY CA
90232-2751
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-3320
  • Fax:
Mailing address:
  • Phone: 310-207-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PATTYE OLMACK
Title or Position: BILLING OFFICE
Credential:
Phone: 818-879-1935