MEDICARE: COMMUNITY CHOICE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G71757	CA

General Provider Information

NPI Number	:	1083848527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CHOICE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	201 W GARVEY AVE
Second Line	:	SUITE 102-614
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-7418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W GARVEY AVE
Second Line	:	SUITE 102-614
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-7418
Country	:	US
Telephone Number	:	626-283-9769
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID D RAND
Credential	:
Telephone Number	:	626-283-9769

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	09/15/2009

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