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NPI Code Detail

MEDICARE: MISALI MED. GR. INC.

MEDICARE: MISALI MED. GR. 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
12085R0202XDiagnostic Radiology PhysicianG11856CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G11856OTHERCAMEDICAL LIC. NO.

General Provider Information

NPI Number : 1417043290
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISALI MED. GR. INC.
Provider Business Mailing Address
First Line : 10430 WILSHIRE BLVD
Second Line : NO. 206
City : LOS ANGELES
State : CA
Zip : 90024-4651
Country : US
Telephone Number : 310-441-9945
Fax Number : 818-782-7026
Provider Business Practice Location Address
First Line : 10430 WILSHIRE BLVD
Second Line : NO. 206
City : LOS ANGELES
State : CA
Zip : 90024-4651
Country : US
Telephone Number : 310-441-9945
Fax Number : 818-782-7026
Authorized Official
Title or Position : PRESIDENT
Name : MICHAEL MANUEL LITWIN
Credential : MD
Telephone Number : 310-441-9945
Provider Enumeration Date : 10/05/2006
Last Update Date : 08/22/2020

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