Healthcare Provider Details

I. General information

NPI: 1881898740
Provider Name (Legal Business Name): JOEL FREDERICK FINE, MD A MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 DE LONGPRE AVE
HOLLYWOOD CA
90028-8253
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 323-462-2271
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA42331
License Number StateCA

VIII. Authorized Official

Name: DR. JOEL F FINE
Title or Position: INCORPORATOR
Credential: M.D.
Phone: 310-792-3914