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General NPI Number Information
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NPI Number | 1184061533
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Entity Type | Organization
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Legal Business Name | PAJA MEDICAL GROUP
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 8301 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3470
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Country | US
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Telephone | 323-778-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 8301 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3470
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Country | US
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Telephone | 323-778-7772
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SUSAN MANABO
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Credential | NP
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Telephone | 949-293-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A65363
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License Number State | CA
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