| Brentwood Medical Group A Professional Medical Corp | |
|
11645 Wilshire Blvd Suite 745 Los Angeles CA 90025-1708 | |
| (310) 696-0101 | |
| Not Available |
| Full Name | Brentwood Medical Group A Professional Medical Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 11645 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Javid Tavari (PRESIDENT) |
| Authorized Official Contact | 3106960101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brentwood Medical Group A Professional Medical Corp 11645 Wilshire Blvd Suite 745 Los Angeles CA 90025-1708 Ph: (310) 696-0101 | Brentwood Medical Group A Professional Medical Corp 11645 Wilshire Blvd Suite 745 Los Angeles CA 90025-1708 Ph: (310) 696-0101 |
| NPI Number | 1720322415 |
|---|---|
| Provider Enumeration Date | 11/19/2012 |
| Last Update Date | 02/26/2018 |
| Medicare PECOS PAC ID | 3577718618 |
|---|---|
| Medicare Enrollment ID | O20130221000318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720322415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20A6273 (California) | Primary |
| Provider Name | Javid D Tavari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669400602 PECOS PAC ID: 4183525389 Enrollment ID: I20040120000557 |
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