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General NPI Number Information
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NPI Number | 1073228177
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Entity Type | Organization
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Legal Business Name | HOUSECALL MD MEDICAL PRACTICE MANAGEMENT, LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 2051 N HIGHLAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90068-1373
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Country | US
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Telephone | 833-432-5633
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Fax | 833-265-2088
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY # 1469
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 833-432-5633
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Fax | 833-265-2088
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Authorized Official
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Title or Position | ADMINISTRATIVE AND LEGAL EXECUTIVE
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Name | TAREVA MARSHALL
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Credential | JD
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Telephone | 757-768-9126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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