Healthcare Provider Details

I. General information

NPI: 1093968414
Provider Name (Legal Business Name): GED MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 FRIAR ST SUITE 112
VAN NUYS CA
91411-2397
US

IV. Provider business mailing address

14545 FRIAR ST SUITE 112
VAN NUYS CA
91411-2397
US

V. Phone/Fax

Practice location:
  • Phone: 310-393-8081
  • Fax:
Mailing address:
  • Phone: 310-393-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES D DIDDIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-393-8081