| Southern California Infectious Disease Medical Group | |
|
201 S Alvarado St Suite 820 Los Angeles CA 90057-2320 | |
| (213) 483-0901 | |
| (213) 483-6650 |
| Full Name | Southern California Infectious Disease Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 201 S Alvarado St, Los Angeles, California |
| Authorized Official Name and Position | Ronald S Fishbach (PARTNER) |
| Authorized Official Contact | 3102746671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Infectious Disease Medical Group 201 S Alvarado St Suite 820 Los Angeles CA 90057-2320 Ph: (213) 483-0901 | Southern California Infectious Disease Medical Group 201 S Alvarado St Suite 820 Los Angeles CA 90057-2320 Ph: (213) 483-0901 |
| NPI Number | 1639100662 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 04/22/2016 |
| Medicare PECOS PAC ID | 5799714135 |
|---|---|
| Medicare Enrollment ID | O20050805000896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639100662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | W11997 (California) | Primary |
| Provider Name | Joseph M Nussbaum |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1922033463 PECOS PAC ID: 0345277539 Enrollment ID: I20050719001163 |
| Provider Name | Suman Mallur Radhakrishna |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1225069248 PECOS PAC ID: 0446255855 Enrollment ID: I20060918000473 |
| Provider Name | Alexander Kim |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1881629335 PECOS PAC ID: 4789680950 Enrollment ID: I20061011000237 |
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