Healthcare Provider Details

I. General information

NPI: 1275278608
Provider Name (Legal Business Name): JML MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 E BEVERLY BLVD
LOS ANGELES CA
90022-2208
US

IV. Provider business mailing address

4200 PECK RD STE B
EL MONTE CA
91732-2177
US

V. Phone/Fax

Practice location:
  • Phone: 626-673-5439
  • Fax:
Mailing address:
  • Phone: 626-673-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDDIE LARES
Title or Position: DIRECTOR
Credential: MD
Phone: 626-673-5439