Healthcare Provider Details

I. General information

NPI: 1063062776
Provider Name (Legal Business Name): NORTH HILLS MEDICAL OFFICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2019
Last Update Date: 09/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15343 PARTHENIA ST
NORTH HILLS CA
91343-5105
US

IV. Provider business mailing address

15343 PARTHENIA ST
NORTH HILLS CA
91343-5105
US

V. Phone/Fax

Practice location:
  • Phone: 424-317-4787
  • Fax: 818-810-9052
Mailing address:
  • Phone: 424-317-4787
  • Fax: 818-810-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRA GROVE
Title or Position: OWNER
Credential: MD
Phone: 424-317-4787