Healthcare Provider Details

I. General information

NPI: 1457725715
Provider Name (Legal Business Name): MED-LEGAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 OVERLAND CT
SAN DIMAS CA
91773-1746
US

IV. Provider business mailing address

955 OVERLAND CT
SAN DIMAS CA
91773-1746
US

V. Phone/Fax

Practice location:
  • Phone: 800-244-3495
  • Fax:
Mailing address:
  • Phone: 800-244-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateCA

VIII. Authorized Official

Name: DAN R JAKLE
Title or Position: COMPLIANCE AND OPERATIONS ARCHITECT
Credential:
Phone: 800-244-3495