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General NPI Number Information
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NPI Number | 1538229323
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Entity Type | Organization
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Legal Business Name | AXIS MEDICAL GROUP
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 326 N SOTO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1815
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Country | US
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Telephone | 323-268-5060
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Fax | 323-268-5048
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Provider Business Mailing Address
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Address Line | 326 N SOTO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1815
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Country | US
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Telephone | 323-268-5060
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Fax | 323-268-5048
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Authorized Official
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Title or Position | PARTNER
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Name | DR. HECTOR LUQUE
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Credential | D.O.
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Telephone | 323-268-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A6453
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A6465
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License Number State | CA
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