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General NPI Number Information
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NPI Number | 1598004830
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICIANS INC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 3710 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90063-2219
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Country | US
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Telephone | 323-980-7777
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Fax | 323-980-7778
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Provider Business Mailing Address
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Address Line | 3710 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90063-2219
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Country | US
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Telephone | 323-980-7777
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Fax | 323-980-7778
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. PAULINE JOSE
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Credential | MD
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Telephone | 323-980-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A75388
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License Number State | CA
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