Healthcare Provider Details

I. General information

NPI: 1174576607
Provider Name (Legal Business Name): PEAK HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 S SEPULVEDA BLVD 300
LOS ANGELES CA
90025-5733
US

IV. Provider business mailing address

2143 S SEPULVEDA BLVD 300
LOS ANGELES CA
90025-5733
US

V. Phone/Fax

Practice location:
  • Phone: 310-575-3100
  • Fax: 310-575-3102
Mailing address:
  • Phone: 310-575-3100
  • Fax: 310-575-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS JACQUELINE BRIZUELA
Title or Position: ADMINISTRATIVE ASSOCIATE/BILLER
Credential:
Phone: 310-575-3100