Healthcare Provider Details

I. General information

NPI: 1942756937
Provider Name (Legal Business Name): CITY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 FLORENCE AVENUE
LOS ANGELES CA
90009
US

IV. Provider business mailing address

PO BOX 881916
LOS ANGELES CA
90009
US

V. Phone/Fax

Practice location:
  • Phone: 323-531-0915
  • Fax:
Mailing address:
  • Phone: 323-531-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA118311
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNP14622
License Number StateCA

VIII. Authorized Official

Name: FRED ONOH
Title or Position: OFFICE MANAGER
Credential:
Phone: 323-531-0915