Healthcare Provider Details

I. General information

NPI: 1124290697
Provider Name (Legal Business Name): DRL MED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD SUITE 701
LOS ANGELES CA
90048-5501
US

IV. Provider business mailing address

6404 WILSHIRE BLVD SUITE 701
LOS ANGELES CA
90048-5501
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-3478
  • Fax: 323-653-2720
Mailing address:
  • Phone: 323-653-3478
  • Fax: 323-653-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA46270
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS DAVIES
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 323-653-3478