Healthcare Provider Details

I. General information

NPI: 1144733825
Provider Name (Legal Business Name): DMB MD GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91605-3149
US

IV. Provider business mailing address

1431 OCEAN AVE APT 1201
SANTA MONICA CA
90401-2147
US

V. Phone/Fax

Practice location:
  • Phone: 818-962-5505
  • Fax: 811-821-6722
Mailing address:
  • Phone: 323-459-1543
  • Fax: 844-800-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA111784
License Number StateCA

VIII. Authorized Official

Name: DR. DARREN MICHAEL BOYER
Title or Position: CEO
Credential: MD
Phone: 323-459-1543