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General NPI Number Information
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NPI Number | 1245491661
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Entity Type | Organization
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Legal Business Name | C-CONRAD GROUP LIMITED
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2601 N WILMINGTON AVE
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City | COMPTON
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State | CA
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Zip | 90222-2004
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Country | US
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Telephone | 323-298-7416
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Fax |
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Provider Business Mailing Address
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Address Line | 8929 S SEPULVEDA BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90045-3643
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Country | US
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Telephone | 323-298-7416
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CYNTHIA MARSHALL
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Credential |
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Telephone | 323-298-7416
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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 |
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License Number State |
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