MEDICARE: PRM GYNECOLOGY OF CALIFORNIA PC

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	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1508681842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRM GYNECOLOGY OF CALIFORNIA PC

Provider Business Mailing Address
First Line	:	2090 PALM BEACH LAKES BLVD STE 700
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6508
Country	:	US
Telephone Number	:	561-422-4206
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 WESTWOOD BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	310-943-6080
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF RCM
Name	:	JANE LAGNESE
Credential	:
Telephone Number	:	561-422-4206

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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