=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386850592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDRENS COMPREHENSIVE MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 04/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3756 SANTA ROSALIA DR SUITE 600
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-299-3200
-----------------------------------------------------
Fax | 323-299-0673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3756 SANTA ROSALIA DR SUITE 600
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-299-3200
-----------------------------------------------------
Fax | 323-299-0673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LLOYD THOMAS HUNTER JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 323-299-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------