Healthcare Provider Details

I. General information

NPI: 1316198997
Provider Name (Legal Business Name): SC PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 N BRAND BLVD
GLENDALE CA
91202-2905
US

IV. Provider business mailing address

946 N BRAND BLVD
GLENDALE CA
91202-2905
US

V. Phone/Fax

Practice location:
  • Phone: 818-662-7000
  • Fax: 818-662-7131
Mailing address:
  • Phone: 626-616-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA98448
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA98448
License Number StateCA

VIII. Authorized Official

Name: DR. MANUEL P MOMJIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-616-6642