Healthcare Provider Details

I. General information

NPI: 1164918892
Provider Name (Legal Business Name): MANCHESTER MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 W MANCHESTER AVE STE A
LOS ANGELES CA
90045-3801
US

IV. Provider business mailing address

6222 W MANCHESTER AVE STE A
LOS ANGELES CA
90045-3801
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-1840
  • Fax: 310-670-4016
Mailing address:
  • Phone: 310-670-1840
  • Fax: 310-670-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY ANDREWIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-670-1840