MEDICARE: GOOD LIFE MEDICAL GROUP, INC.

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	208000000X	Pediatrics Physician	A050818	CA
2	207Q00000X	Family Medicine Physician	20A6005	CA

General Provider Information

NPI Number	:	1316940828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIFE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3650 SOUTH ST
Second Line	:	STE 204
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1521
Country	:	US
Telephone Number	:	562-602-8841
Fax Number	:	562-602-8843

Provider Business Practice Location Address
First Line	:	3650 SOUTH ST
Second Line	:	STE 204
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1521
Country	:	US
Telephone Number	:	562-602-8841
Fax Number	:	562-602-8843

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. PETER HUGH
Credential	:	D.O.
Telephone Number	:	562-602-8841

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/14/2010

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Directions to “GOOD LIFE MEDICAL GROUP, INC. ” Practice Location

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