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General NPI Number Information
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NPI Number | 1083946180
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Entity Type | Organization
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Legal Business Name | PLATINUM MEDICAL GROUP
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 21520 PIONEER BLVD STE 203
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716-2601
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Country | US
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Telephone | 562-402-2818
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Fax | 562-402-2545
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Provider Business Mailing Address
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Address Line | 27762 ANTONIO PKWY STE L1-433
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City | LADERA RANCH
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State | CA
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Zip | 92694-1140
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Country | US
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Telephone | 562-402-2818
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Fax | 562-402-2545
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL RANDALL
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Credential |
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Telephone | 562-402-2818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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