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General NPI Number Information
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NPI Number | 1619445640
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Entity Type | Organization
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Legal Business Name | SERPAH MEDICAL PC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 710
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City | LOS ANGELES
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State | CA
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Zip | 90067-2010
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Country | US
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Telephone | 424-274-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E STE 710
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City | LOS ANGELES
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State | CA
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Zip | 90067-2010
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Country | US
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Telephone | 424-274-3211
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEVIN MATTHEW NELSON
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Credential |
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Telephone | 310-883-8920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0001X
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Taxonomy Name | Clinical & Laboratory Immunology (Internal 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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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