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General NPI Number Information
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NPI Number | 1912396300
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Entity Type | Organization
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Legal Business Name | IONE MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 3435 WILSHIRE BLVD 500
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City | LOS ANGELES
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State | CA
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Zip | 90010-1901
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Country | US
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Telephone | 213-384-5550
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Fax | 213-384-5558
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Provider Business Mailing Address
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Address Line | 3435 WILSHIRE BLVD 500
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City | LOS ANGELES
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State | CA
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Zip | 90010-1901
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Country | US
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Telephone | 213-384-5550
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Fax | 213-384-5558
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LEE SCHREIBER
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Credential | DO
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Telephone | 213-384-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A5391
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License Number State | CA
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