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General NPI Number Information
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NPI Number | 1164972345
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Entity Type | Organization
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Legal Business Name | AMITY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 608
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City | LOS ANGELES
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State | CA
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Zip | 90067-2009
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Country | US
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Telephone | 310-801-8333
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Fax | 877-563-0602
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Provider Business Mailing Address
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Address Line | 10351 WILSHIRE BLVD 202
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City | LOS ANGELES
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State | CA
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Zip | 90024-4736
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Country | US
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Telephone | 310-801-8333
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Fax | 877-563-0602
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHAEL WATSON
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Credential |
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Telephone | 562-305-9238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A77236
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License Number State | CA
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