Healthcare Provider Details

I. General information

NPI: 1396596763
Provider Name (Legal Business Name): HEALTH FIRST PHYSICIAN ASSISTANTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 AVIATION BLVD STE D
REDONDO BEACH CA
90278-4055
US

IV. Provider business mailing address

11041 SANTA MONICA BLVD # 515
LOS ANGELES CA
90025-3523
US

V. Phone/Fax

Practice location:
  • Phone: 310-464-7042
  • Fax: 888-400-4948
Mailing address:
  • Phone: 310-464-7042
  • Fax: 888-400-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HENRY OKONKWO
Title or Position: CEO
Credential: PA
Phone: 310-464-7042