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NPI Code Detail

MEDICARE: UNITED PHYSICIANS MULTISPECIALTY GROUP INC.

MEDICARE: UNITED PHYSICIANS MULTISPECIALTY 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
1302F00000XExclusive Provider OrganizationFNP 34335CA

General Provider Information

NPI Number : 1396780870
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED PHYSICIANS MULTISPECIALTY GROUP INC.
Provider Business Mailing Address
First Line : 1930 WILSHIRE BLVD
Second Line : SUITE 410
City : LOS ANGELES
State : CA
Zip : 90057-3605
Country : US
Telephone Number : 213-413-4203
Fax Number : 213-413-5615
Provider Business Practice Location Address
First Line : 342 W SAN YSIDRO BLVD
Second Line : SUITE K
City : SAN DIEGO
State : CA
Zip : 92173-2495
Country : US
Telephone Number : 619-428-7432
Fax Number : 619-428-1402
Authorized Official
Title or Position : PRESIDENT
Name : RANDALL HRABKO
Credential : M.D.
Telephone Number : 213-413-4203
Provider Enumeration Date : 06/18/2006
Last Update Date : 08/22/2020

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