Healthcare Provider Details

I. General information

NPI: 1548574056
Provider Name (Legal Business Name): LA FAMILIA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 WHITTIER BLVD
LOS ANGELES CA
90022-4627
US

IV. Provider business mailing address

6433 WHITTIER BLVD
LOS ANGELES CA
90022-4627
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-6674
  • Fax: 323-724-9926
Mailing address:
  • Phone: 323-724-6674
  • Fax: 323-724-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG24174
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG24174
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL ROBERT BLOCK
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 323-724-6674