Healthcare Provider Details

I. General information

NPI: 1679511612
Provider Name (Legal Business Name): PEARL MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11860 WILSHIRE BLVD 100
LOS ANGELES CA
90025-6613
US

IV. Provider business mailing address

11860 WILSHIRE BLVD 100
LOS ANGELES CA
90025-6613
US

V. Phone/Fax

Practice location:
  • Phone: 310-312-1111
  • Fax: 310-312-1114
Mailing address:
  • Phone: 310-312-1111
  • Fax: 310-312-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICE MEYLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-312-1111