MEDICARE: CALIFORNIA HEALTH MED GR

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700069705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA HEALTH MED GR

Provider Business Mailing Address
First Line	:	635 S WESTLAKE AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3525
Country	:	US
Telephone Number	:	213-386-0010
Fax Number	:	213-386-4190

Provider Business Practice Location Address
First Line	:	635 S WESTLAKE AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3525
Country	:	US
Telephone Number	:	213-386-0010
Fax Number	:	213-386-4190

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JOSEFINA VISTE
Credential	:	MD
Telephone Number	:	213-386-0010

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	04/06/2015

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Directions to “CALIFORNIA HEALTH MED GR ” Practice Location

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