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General NPI Number Information
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NPI Number | 1578031910
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Entity Type | Organization
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Legal Business Name | PROMED SERVICE CENTER INC.
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Dates
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Enumeration Date | 11/04/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 4910 CASTANA AVE
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City | LAKEWOOD
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State | CA
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Zip | 90712-3234
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Country | US
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Telephone | 562-531-6140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | PARAMOUNT
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State | CA
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Zip | 90723-1598
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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 | PROVIDER
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Name | SAM ABDELMELEK
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Credential |
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Telephone | 800-742-8062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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