Healthcare Provider Details

I. General information

NPI: 1013918119
Provider Name (Legal Business Name): MICHAEL JEROME SINGLETON M.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 S BROADWAY
LOS ANGELES CA
90003-3635
US

IV. Provider business mailing address

PO BOX 5167
OCEANSIDE CA
92052-5167
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-1197
  • Fax: 323-750-0330
Mailing address:
  • Phone: 310-600-6046
  • Fax: 323-750-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA064610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: