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General NPI Number Information
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NPI Number | 1144733825
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Entity Type | Organization
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Legal Business Name | DMB MD GROUP INC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 7535 LAUREL CANYON BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-3149
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Country | US
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Telephone | 818-962-5505
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Fax | 811-821-6722
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Provider Business Mailing Address
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Address Line | 1431 OCEAN AVE APT 1201
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City | SANTA MONICA
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State | CA
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Zip | 90401-2147
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Country | US
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Telephone | 323-459-1543
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Fax | 844-800-5249
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Authorized Official
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Title or Position | CEO
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Name | DR. DARREN MICHAEL BOYER
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Credential | MD
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Telephone | 323-459-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A111784
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License Number State | CA
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