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General NPI Number Information
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NPI Number | 1487530226
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Entity Type | Organization
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Legal Business Name | MULTI SPECIALTY MEDICAL GROUP PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1318 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-1935
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Country | US
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Telephone | 213-583-4066
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Fax | 213-554-1387
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Provider Business Mailing Address
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Address Line | 1318 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-1935
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Country | US
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Telephone | 213-583-4066
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Fax | 213-554-1387
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | LAWRENCE MORA
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Credential | MD
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Telephone | 213-583-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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