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NPI Code Detail

MEDICARE: LEISURE WORLD MEDICAL GROUP, INC

MEDICARE: LEISURE WORLD 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
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianA43564CA

General Provider Information

NPI Number : 1457381717
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEISURE WORLD MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : PO BOX 2685
Second Line :
City : SEAL BEACH
State : CA
Zip : 90740-1685
Country : US
Telephone Number : 562-795-6300
Fax Number : 562-795-6350
Provider Business Practice Location Address
First Line : 1661 GOLDEN RAIN RD
Second Line :
City : SEAL BEACH
State : CA
Zip : 90740-4907
Country : US
Telephone Number : 562-795-6300
Fax Number : 562-795-6350
Authorized Official
Title or Position : SHAREHOLDER
Name : SANATKUMAR PATEL
Credential : MD
Telephone Number : 562-281-1245
Provider Enumeration Date : 07/03/2006
Last Update Date : 07/09/2015

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Directions to “LEISURE WORLD MEDICAL GROUP, INC ” Practice Location

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