| La Jolla Medical Group Inc | |
|
6221 Wilshire Blvd Suite 509 Los Angeles CA 90048-5201 | |
| (323) 653-6431 | |
| (323) 653-3895 |
| Full Name | La Jolla Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 6221 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Masha J Livhits (PRESIDENT) |
| Authorized Official Contact | 3236536431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Jolla Medical Group Inc 6221 Wilshire Blvd Suite 509 Los Angeles CA 90048-5201 Ph: (323) 653-6431 | La Jolla Medical Group Inc 6221 Wilshire Blvd Suite 509 Los Angeles CA 90048-5201 Ph: (323) 653-6431 |
| NPI Number | 1811385230 |
|---|---|
| Provider Enumeration Date | 01/07/2015 |
| Last Update Date | 12/14/2016 |
| Medicare PECOS PAC ID | 5698090348 |
|---|---|
| Medicare Enrollment ID | O20150220002211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811385230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | A103993 (California) | Primary |
| Provider Name | Masha J Livhits |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659566875 PECOS PAC ID: 7012131915 Enrollment ID: I20140616002032 |
| Provider Name | David C Remy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1508131509 PECOS PAC ID: 3274562624 Enrollment ID: I20200326001889 |
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