MEDICARE: NEXT DOOR MED NET 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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1497258263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXT DOOR MED NET INC.

Provider Business Mailing Address
First Line	:	5832 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3712
Country	:	US
Telephone Number	:	323-750-7354
Fax Number	:	323-750-7446

Provider Business Practice Location Address
First Line	:	5832 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3712
Country	:	US
Telephone Number	:	323-750-7354
Fax Number	:	323-750-7446

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	NICHOLAS A ROGERS
Credential	:	MD
Telephone Number	:	323-750-7354

Provider Enumeration Date	:	03/17/2018
Last Update Date	:	03/17/2018

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