MEDICARE: IONE 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	208D00000X	General Practice Physician	20A5391	CA

General Provider Information

NPI Number	:	1912396300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IONE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	500
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	213-384-5550
Fax Number	:	213-384-5558

Provider Business Practice Location Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	500
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	213-384-5550
Fax Number	:	213-384-5558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL LEE SCHREIBER
Credential	:	DO
Telephone Number	:	213-384-5550

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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