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General NPI Number Information
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NPI Number | 1992218101
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Entity Type | Organization
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Legal Business Name | REDONDO BEACH PHYSICAL MEDICINE
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 901 N PACIFIC COAST HWY STE 101
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2162
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Country | US
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Telephone | 310-379-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N PACIFIC COAST HWY STE 101
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2162
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Country | US
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Telephone | 310-379-3303
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. IVAN SANCHEZ
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Credential | DC
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Telephone | 310-379-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NPF95007657
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A118026
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License Number State | CA
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