Healthcare Provider Details

I. General information

NPI: 1841338688
Provider Name (Legal Business Name): CENTRAL NEIGHBORHOOD MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 S CENTRAL AVE
LOS ANGELES CA
90011-5527
US

IV. Provider business mailing address

2707 S CENTRAL AVE
LOS ANGELES CA
90011-5527
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-5000
  • Fax: 323-231-3985
Mailing address:
  • Phone: 323-234-5000
  • Fax: 323-231-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA21064
License Number StateCA

VIII. Authorized Official

Name: DR. BASSETT H.L. BROWN
Title or Position: PRESIDENT
Credential: M.D
Phone: 323-234-5000