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General NPI Number Information
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NPI Number | 1356872667
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Entity Type | Organization
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Legal Business Name | AG INFECTIOUS DISEASES, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 11301 W OLYMPIC BLVD SUITE 121-435
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City | LOS ANGELES
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State | CA
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Zip | 90064-1653
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Country | US
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Telephone | 424-256-6682
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 W OLYMPIC BLVD SUITE 121-435
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City | LOS ANGELES
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State | CA
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Zip | 90064-1653
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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 | ARIC GREGSON
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Credential | MD
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Telephone | 424-256-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A68156
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License Number State | CA
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