| Fagan Er Medical Group Inc | |
|
1225 Wilshire Boulevard Los Angeles CA 90017-2395 | |
| (213) 482-2741 | |
| Not Available |
| Full Name | Fagan Er Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1225 Wilshire Boulevard, Los Angeles, California |
| Authorized Official Name and Position | Philip J. Fagan (PRESIDENT) |
| Authorized Official Contact | 8185570135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fagan Er Medical Group Inc 520 N Central Ave Suite 750 Glendale CA 91203-1926 Ph: (818) 557-0135 | Fagan Er Medical Group Inc 1225 Wilshire Boulevard Los Angeles CA 90017-2395 Ph: (213) 482-2741 |
| NPI Number | 1588689236 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 12/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588689236 | NPI | - | NPPES |
| CC6682 | Other | CA | GOOD SAM RAILROAD |
| GR0048650 | Medicaid | CA | |
| ZZZ43319Z | Other | CA | GOOD SAM BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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