Healthcare Provider Details

I. General information

NPI: 1437735115
Provider Name (Legal Business Name): MONARCH CONCIERGE PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 W SUNSET BLVD STE 190
LOS ANGELES CA
90069-2210
US

IV. Provider business mailing address

8730 W SUNSET BLVD STE 190
LOS ANGELES CA
90069-2210
US

V. Phone/Fax

Practice location:
  • Phone: 323-213-9263
  • Fax: 310-602-6529
Mailing address:
  • Phone: 323-213-9263
  • Fax: 310-602-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN MICHAEL GREENE
Title or Position: PHYSICIAN
Credential: DO
Phone: 630-569-1287