Healthcare Provider Details

I. General information

NPI: 1447003983
Provider Name (Legal Business Name): LAKEWOOD HOSPITALIST MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTH ST
LAKEWOOD CA
90712-1419
US

IV. Provider business mailing address

898 N PACIFIC COAST HWY STE 600
EL SEGUNDO CA
90245-2747
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax: 310-379-4856
Mailing address:
  • Phone: 310-321-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK R BELL
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143