Healthcare Provider Details

I. General information

NPI: 1841427226
Provider Name (Legal Business Name): JEFFREY TUMOLVA ANGELES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

PO BOX 54679
LOS ANGELES CA
90054-0679
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5252
  • Fax: 310-967-1773
Mailing address:
  • Phone: 310-423-5252
  • Fax: 310-967-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA126731
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA126731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: