| Specialty Medical Group Ca Pc | |
|
1230 Rosecrans Ave Ste 300 Manhattan Beach CA 90266-2494 | |
| (310) 878-6978 | |
| Not Available |
| Full Name | Specialty Medical Group Ca Pc |
|---|---|
| Speciality | General Practice |
| Location | 1230 Rosecrans Ave Ste 300, Manhattan Beach, California |
| Authorized Official Name and Position | Joel Jones (OWNER) |
| Authorized Official Contact | 4796858837 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialty Medical Group Ca Pc 1230 Rosecrans Ave Ste 300 Manhattan Beach CA 90266-2494 Ph: (310) 878-6978 | Specialty Medical Group Ca Pc 1230 Rosecrans Ave Ste 300 Manhattan Beach CA 90266-2494 Ph: (310) 878-6978 |
| NPI Number | 1518716240 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 05/15/2024 |
| Medicare PECOS PAC ID | 9739625211 |
|---|---|
| Medicare Enrollment ID | O20240719002956 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518716240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Doris Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487381786 PECOS PAC ID: 9335524529 Enrollment ID: I20220925000050 |
| Provider Name | Oghogho Uhunmwangho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467159590 PECOS PAC ID: 4486011368 Enrollment ID: I20230608000455 |
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