Healthcare Provider Details

I. General information

NPI: 1710214234
Provider Name (Legal Business Name): LOS ANGELES CARDIOVASCULAR CONSULTANTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD. SUITE 825
LOS ANGELES CA
90025
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-3320
  • Fax:
Mailing address:
  • Phone: 310-207-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD HYMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-207-3320