Healthcare Provider Details

I. General information

NPI: 1235751405
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA PHYSICIAN ASSISTANT MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 AERICK ST STE 3
INGLEWOOD CA
90301-4884
US

IV. Provider business mailing address

645 AERICK ST STE 3
INGLEWOOD CA
90301-4884
US

V. Phone/Fax

Practice location:
  • Phone: 310-431-4926
  • Fax:
Mailing address:
  • Phone: 310-431-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH DAVID SILVERSTEIN
Title or Position: PRESIDENT
Credential: PA
Phone: 805-732-9712