MEDICARE: JREH MEDICAL CLINIC INC. DBA

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	3140N1450X	Pediatric Skilled Nursing Facility	C22547	CA

General Provider Information

NPI Number	:	1356748123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JREH MEDICAL CLINIC INC. DBA

Provider Business Mailing Address
First Line	:	615 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3211
Country	:	US
Telephone Number	:	323-399-3000
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ALVA MARSH
Credential	:	M.D
Telephone Number	:	323-399-3000

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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