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General NPI Number Information
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NPI Number | 1245317411
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Entity Type | Organization
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Legal Business Name | MEDICAL GROUP ASSOCIATES INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 8501 WILSHIRE BLVD 316
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3101
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Country | US
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Telephone | 310-652-2255
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Fax | 310-652-3580
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Provider Business Mailing Address
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Address Line | 8501 WILSHIRE BLVD 316
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3101
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Country | US
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Telephone | 310-652-2255
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Fax | 310-652-3580
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Authorized Official
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Title or Position | PRECIDENT
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Name | DR. IVAN RICHARD JACOBS
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Credential | M.D.
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Telephone | 310-652-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C27493
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License Number State | CA
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