Healthcare Provider Details

I. General information

NPI: 1528876547
Provider Name (Legal Business Name): NPC MEDICAL GROUP, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N VERMONT AVE
LOS ANGELES CA
90029-2620
US

IV. Provider business mailing address

1002 N VERMONT AVE
LOS ANGELES CA
90029-2620
US

V. Phone/Fax

Practice location:
  • Phone: 323-922-1022
  • Fax: 323-922-1021
Mailing address:
  • Phone: 323-922-1022
  • Fax: 323-922-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO MELENDEZ
Title or Position: GENERAL MANAGER
Credential:
Phone: 310-918-9100