| Shore To Shore Medical Group | |
|
18546 Roscoe Blvd Suite 302 Northridge CA 91324-4663 | |
| (818) 886-1100 | |
| (818) 886-7501 |
| Full Name | Shore To Shore Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 18546 Roscoe Blvd, Northridge, California |
| Authorized Official Name and Position | Philip S Shore (MD) |
| Authorized Official Contact | 8188861100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore To Shore Medical Group 18546 Roscoe Blvd Suite 302 Northridge CA 91324-4663 Ph: (818) 886-1100 | Shore To Shore Medical Group 18546 Roscoe Blvd Suite 302 Northridge CA 91324-4663 Ph: (818) 886-1100 |
| NPI Number | 1568481315 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 06/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568481315 | NPI | - | NPPES |
| 00G718240 | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G071824 (California) | Primary |
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