MEDICARE: L & L PHYSICIAN SERVICES, LLC

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1336237262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L & L PHYSICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	14140 ALONDRA BLVD
Second Line	:	E
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-5821
Country	:	US
Telephone Number	:	562-229-3144
Fax Number	:	562-229-3142

Provider Business Practice Location Address
First Line	:	14140 ALONDRA BLVD
Second Line	:	E
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-5821
Country	:	US
Telephone Number	:	562-229-3144
Fax Number	:	562-229-3142

Authorized Official
Title or Position	:	OWNER / BILLER
Name	:	LUANN JOHNSON
Credential	:
Telephone Number	:	562-229-3144

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2020

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