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General NPI Number Information
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NPI Number | 1972753960
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Entity Type | Organization
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Legal Business Name | CHARLES DREW UNIVERSITY MULTI-SPECIALTY GROUP INC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 11722 WILMINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90059-2543
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Country | US
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Telephone | 323-249-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 MARTIN LUTHER KING JR BLVD SUITE 401
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City | LYNWOOD
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State | CA
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Zip | 90262-3513
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Country | US
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Telephone | 310-669-8843
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD BAKER
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Credential | MD
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Telephone | 310-669-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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