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General NPI Number Information
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NPI Number | 1265473672
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Entity Type | Organization
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Legal Business Name | UNITED PHYSICIAN MULTISPECIALTY GROUP INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 1037 E PACIFIC COAST HWY
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City | WILMINGTON
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State | CA
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Zip | 90744-2726
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Country | US
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Telephone | 310-549-6950
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 WILSHIRE BLVD SUITE 410
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City | LOS ANGELES
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State | CA
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Zip | 90057-3605
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Country | US
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Telephone | 213-413-4203
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Fax | 213-413-5615
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDALL HRABKO
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Credential | M.D.
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Telephone | 213-413-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | FNP34335
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G39326
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License Number State | CA
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