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General NPI Number Information
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NPI Number | 1083848527
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHOICE MEDICAL CENTER
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 201 W GARVEY AVE SUITE 102-614
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City | MONTEREY PARK
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State | CA
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Zip | 91754-7418
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Country | US
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Telephone | 626-283-9769
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W GARVEY AVE SUITE 102-614
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City | MONTEREY PARK
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State | CA
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Zip | 91754-7418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID D RAND
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Credential |
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Telephone | 626-283-9769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G71757
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License Number State | CA
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