Healthcare Provider Details

I. General information

NPI: 1013041151
Provider Name (Legal Business Name): RMG MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15082 IMPERIAL HWY
LA MIRADA CA
90638-1301
US

IV. Provider business mailing address

PO BOX 511201
LOS ANGELES CA
90051-2998
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-6600
  • Fax:
Mailing address:
  • Phone: 562-947-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC23710
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMOND GOMBERG
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 562-947-6600