| Great Spirit Medical Group,inc | |
|
9900 Balboa Blvd Suite A Northridge CA 91325-5403 | |
| (818) 701-0017 | |
| (818) 701-0073 |
| Full Name | Great Spirit Medical Group,inc |
|---|---|
| Speciality | Family Medicine |
| Location | 9900 Balboa Blvd, Northridge, California |
| Authorized Official Name and Position | Conrado J.r Miranda (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8187010017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Spirit Medical Group,inc 9900 Balboa Blvd Suite A Northridge CA 91325-5403 Ph: (818) 701-0017 | Great Spirit Medical Group,inc 9900 Balboa Blvd Suite A Northridge CA 91325-5403 Ph: (818) 701-0017 |
| NPI Number | 1407869928 |
|---|---|
| Provider Enumeration Date | 08/14/2006 |
| Last Update Date | 11/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407869928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A48817 (California) | Primary |
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