Healthcare Provider Details

I. General information

NPI: 1669405890
Provider Name (Legal Business Name): CALIFORNIA PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 AIRLANE AVE
LOS ANGELES CA
90045-3010
US

IV. Provider business mailing address

7901 AIRLANE AVE
LOS ANGELES CA
90045-3010
US

V. Phone/Fax

Practice location:
  • Phone: 310-902-0902
  • Fax: 310-670-6735
Mailing address:
  • Phone: 310-902-0902
  • Fax: 310-670-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA71843
License Number StateCA

VIII. Authorized Official

Name: DR. RITO CASTANON-HILL
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 310-902-0903