Healthcare Provider Details

I. General information

NPI: 1578221453
Provider Name (Legal Business Name): HP INTENSIVIST MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE
LOS ANGELES CA
90027-6098
US

IV. Provider business mailing address

PO BOX 80665
CITY OF INDUSTRY CA
91716-8414
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax: 310-379-4856
Mailing address:
  • Phone: 310-698-5452
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK R BELL
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143