| Sevilla Medical Group Inc | |
|
2813 N Broadway Los Angeles CA 90031-2611 | |
| (323) 342-9764 | |
| (323) 342-9656 |
| Full Name | Sevilla Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2813 N Broadway, Los Angeles, California |
| Authorized Official Name and Position | Tomas Sevilla (OWNER) |
| Authorized Official Contact | 3233429764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sevilla Medical Group Inc Po Box 31340 Los Angeles CA 90031-0340 Ph: (323) 342-9764 | Sevilla Medical Group Inc 2813 N Broadway Los Angeles CA 90031-2611 Ph: (323) 342-9764 |
| NPI Number | 1871757302 |
|---|---|
| Provider Enumeration Date | 07/14/2008 |
| Last Update Date | 05/26/2010 |
| Medicare PECOS PAC ID | 6608903075 |
|---|---|
| Medicare Enrollment ID | O20100416000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871757302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A63670 (California) | Primary |
| Provider Name | Tomas A Sevilla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922189125 PECOS PAC ID: 2961478995 Enrollment ID: I20040909001077 |
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