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General NPI Number Information
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NPI Number | 1669188314
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Entity Type | Organization
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Legal Business Name | HERMD VIRTUAL SERVICES CA, P.C.
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 776 BARRACUDA WAY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-4123
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Country | US
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Telephone | 949-554-3211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340380 PMB 37348
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City | COLUMBUS
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State | OH
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Zip | 43234
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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 | DIRECTOR
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Name | DR. JEROME CHELLIAH
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Credential | MD
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Telephone | 707-720-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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