Healthcare Provider Details

I. General information

NPI: 1326410457
Provider Name (Legal Business Name): TELEGRAPH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 TELEGRAPH RD
PICO RIVERA CA
90660-5523
US

IV. Provider business mailing address

9505 TELEGRAPH RD
PICO RIVERA CA
90660-5523
US

V. Phone/Fax

Practice location:
  • Phone: 562-842-3595
  • Fax: 562-842-3598
Mailing address:
  • Phone: 562-842-3595
  • Fax: 562-842-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number261QH0100X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC35999
License Number StateCA

VIII. Authorized Official

Name: MARC H FRIEDMAN
Title or Position: MANAGER
Credential: CEO
Phone: 562-842-3595