Healthcare Provider Details

I. General information

NPI: 1053742106
Provider Name (Legal Business Name): PLATINUM HEALTH PARTNERS A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 ARTESIA BLVD STE 105
REDONDO BEACH CA
90278-3412
US

IV. Provider business mailing address

2850 ARTESIA BLVD STE 105
REDONDO BEACH CA
90278-3412
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-4303
  • Fax: 310-419-4480
Mailing address:
  • Phone: 310-419-4303
  • Fax: 310-419-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. IFRAIN CONTRERAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-419-4303