Healthcare Provider Details

I. General information

NPI: 1033299466
Provider Name (Legal Business Name): HEALTHCARE PARTNERS MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W OLYMPIC BLVD
LOS ANGELES CA
90015-1329
US

IV. Provider business mailing address

P.O. BOX 6400
TORRANCE CA
90504-6400
US

V. Phone/Fax

Practice location:
  • Phone: 213-236-0310
  • Fax: 213-239-5011
Mailing address:
  • Phone: 213-236-0310
  • Fax: 213-239-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA43374
License Number StateCA

VIII. Authorized Official

Name: JOHN G. LIETHEN
Title or Position: SECRETARY
Credential:
Phone: 952-205-6262