| Jaga Medical Group Inc | |
|
1400 Colorado Blvd A Eagle Rock CA 90041-2321 | |
| (323) 999-2250 | |
| (323) 999-2241 |
| Full Name | Jaga Medical Group Inc |
|---|---|
| Speciality | General Practice |
| Location | 1400 Colorado Blvd, Eagle Rock, California |
| Authorized Official Name and Position | Ardienne Ann Grant (PRESIDENT) |
| Authorized Official Contact | 3239992250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jaga Medical Group Inc 1400 Colorado Blvd A Eagle Rock CA 90041-2321 Ph: (323) 999-2250 | Jaga Medical Group Inc 1400 Colorado Blvd A Eagle Rock CA 90041-2321 Ph: (323) 999-2250 |
| NPI Number | 1356898357 |
|---|---|
| Provider Enumeration Date | 09/07/2016 |
| Last Update Date | 10/20/2016 |
| Medicare PECOS PAC ID | 1456639186 |
|---|---|
| Medicare Enrollment ID | O20161031001317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356898357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 20A7285 (California) | Primary |
| Provider Name | Adrienne A Grant |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1063571834 PECOS PAC ID: 5597866764 Enrollment ID: I20070718000764 |
| Provider Name | Meri Petrosyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306513270 PECOS PAC ID: 3072910652 Enrollment ID: I20210923003500 |
Ricardo Roman Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4708 Eagle Rock Blvd, Eagle Rock, CA 90041 Phone: 323-254-3701 |