Healthcare Provider Details

I. General information

NPI: 1679981872
Provider Name (Legal Business Name): PACIFIC HARBOR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N PACIFIC COAST HWY STE 3000
EL SEGUNDO CA
90245-4430
US

IV. Provider business mailing address

360 N PACIFIC COAST HWY STE 3000
EL SEGUNDO CA
90245-4430
US

V. Phone/Fax

Practice location:
  • Phone: 310-642-0100
  • Fax: 310-642-0546
Mailing address:
  • Phone: 310-642-0100
  • Fax: 310-642-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. PETER NABIL MIKHAIL
Title or Position: PARTNER/PHYSICIAN
Credential:
Phone: 310-642-0100