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General NPI Number Information
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NPI Number | 1235751405
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA PHYSICIAN ASSISTANT MEDICAL GROUP PC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 645 AERICK ST STE 3
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City | INGLEWOOD
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State | CA
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Zip | 90301-4884
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Country | US
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Telephone | 310-431-4926
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Fax |
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Provider Business Mailing Address
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Address Line | 645 AERICK ST STE 3
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City | INGLEWOOD
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State | CA
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Zip | 90301-4884
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Country | US
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Telephone | 310-431-4926
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH DAVID SILVERSTEIN
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Credential | PA
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Telephone | 805-732-9712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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