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General NPI Number Information
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NPI Number | 1932184223
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Entity Type | Organization
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Legal Business Name | MADISON PARK FAMILY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 1970 SO PROSPECT AVE STE 3
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City | REDONDO BEACH
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State | CA
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Zip | 90277
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Country | US
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Telephone | 310-944-9344
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Fax | 310-944-9390
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Provider Business Mailing Address
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Address Line | 1970 SO PROSPECT AVE STE 3
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City | REDONDO BEACH
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State | CA
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Zip | 90277
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Country | US
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Telephone | 310-944-9344
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Fax | 310-944-9390
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Authorized Official
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Title or Position | MD
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Name | EDUARDO J ANORGA
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Credential | MD
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Telephone | 310-944-9344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G56001
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License Number State | CA
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