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General NPI Number Information
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NPI Number | 1689939787
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Entity Type | Organization
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Legal Business Name | CEDARS TOWER MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 8631 W 3RD ST STE 1140
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City | LOS ANGELES
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State | CA
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Zip | 90048-5965
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Country | US
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Telephone | 323-712-1411
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Fax | 818-506-9030
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Provider Business Mailing Address
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Address Line | 8631 W 3RD ST STE 1140
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City | LOS ANGELES
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State | CA
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Zip | 90048-5965
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Country | US
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Telephone | 323-712-1411
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Fax | 818-506-9030
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | ALINA KIEVSKY
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Credential | NP
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Telephone | 323-606-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 21671
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License Number State | CA
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