Healthcare Provider Details

I. General information

NPI: 1386850592
Provider Name (Legal Business Name): CHILDRENS COMPREHENSIVE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR SUITE 600
LOS ANGELES CA
90008
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR SUITE 600
LOS ANGELES CA
90008
US

V. Phone/Fax

Practice location:
  • Phone: 323-299-3200
  • Fax: 323-299-0673
Mailing address:
  • Phone: 323-299-3200
  • Fax: 323-299-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD THOMAS HUNTER JR.
Title or Position: DIRECTOR
Credential: MD
Phone: 323-299-3200