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General NPI Number Information
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NPI Number | 1750524997
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Entity Type | Organization
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Legal Business Name | P. M. G.
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 2007 WILSHIRE BLVD SUITE 714
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City | LOS ANGELES
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State | CA
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Zip | 90057-3506
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Country | US
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Telephone | 818-500-9910
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Fax | 818-956-3300
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Provider Business Mailing Address
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Address Line | PO BOX 761400
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City | LOS ANGELES
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State | CA
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Zip | 90076-1400
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Country | US
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Telephone | 818-500-9910
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Fax | 818-956-3300
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | B ROCK CHOE
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Credential | M.D.
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Telephone | 818-500-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | FNP 8917
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License Number State | CA
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