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General NPI Number Information
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NPI Number | 1821894288
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Entity Type | Organization
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Legal Business Name | LIFESPRING MEDICAL GROUP
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 710 S CENTRAL AVE STE 310
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City | GLENDALE
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State | CA
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Zip | 91204-4641
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Country | US
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Telephone | 818-396-5190
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Fax | 818-396-5197
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Provider Business Mailing Address
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Address Line | 710 S CENTRAL AVE STE 310
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City | GLENDALE
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State | CA
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Zip | 91204-4641
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Country | US
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Telephone | 818-396-5190
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ADRIENNE GRANT
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Credential | DO
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Telephone | 818-396-5190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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