Healthcare Provider Details

I. General information

NPI: 1528048022
Provider Name (Legal Business Name): CENTER FOR SPECIALTY CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N NASH ST
EL SEGUNDO CA
90245-2817
US

IV. Provider business mailing address

500 N NASH ST
EL SEGUNDO CA
90245-2817
US

V. Phone/Fax

Practice location:
  • Phone: 310-640-9911
  • Fax:
Mailing address:
  • Phone: 310-640-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESE HERNANDEZ
Title or Position: SENIOR VP
Credential:
Phone: 310-640-9911