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General NPI Number Information
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NPI Number | 1356748123
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Entity Type | Organization
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Legal Business Name | JREH MEDICAL CLINIC INC. DBA
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 615 S ATLANTIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3211
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Country | US
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Telephone | 323-399-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 615 S ATLANTIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALVA MARSH
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Credential | M.D
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Telephone | 323-399-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | C22547
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License Number State | CA
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