Healthcare Provider Details

I. General information

NPI: 1861418576
Provider Name (Legal Business Name): MULTI HEALTH CARE MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 FIRESTONE BLVD
SOUTH GATE CA
90280-2951
US

IV. Provider business mailing address

3175 FIRESTONE BLVD
SOUTH GATE CA
90280-2951
US

V. Phone/Fax

Practice location:
  • Phone: 323-567-8910
  • Fax: 323-567-8953
Mailing address:
  • Phone: 323-567-8910
  • Fax: 323-567-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA55940
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG78454
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA48912
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA39722
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA 35877
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG 23113
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT 11601
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA 76527
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE 2963
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 17142
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16740
License Number StateCA

VIII. Authorized Official

Name: MR. GLENN A MARSHAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-567-8910