MEDICARE: ISABEL 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
1	207R00000X	Internal Medicine Physician	A36092	CA

General Provider Information

NPI Number	:	1821325523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISABEL MEDICAL GROUP,INC

Provider Business Mailing Address
First Line	:	4407 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2731
Country	:	US
Telephone Number	:	323-231-0106
Fax Number	:	323-231-6351

Provider Business Practice Location Address
First Line	:	4407 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2731
Country	:	US
Telephone Number	:	323-231-0106
Fax Number	:	323-231-6351

Authorized Official
Title or Position	:	SECRETARY
Name	:	EDWARD BUI HAI
Credential	:	MD
Telephone Number	:	323-231-0106

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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