| St Nicholas Medical Group | |
|
5520 Santa Monica Blvd Suite 112 Los Angeles CA 90038-2932 | |
| (323) 860-9054 | |
| (323) 860-9053 |
| Full Name | St Nicholas Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 5520 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Jacob N Flores (PARTNER) |
| Authorized Official Contact | 3238609054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Nicholas Medical Group 5520 Santa Monica Blvd Suite 112 Los Angeles CA 90038-2932 Ph: (323) 860-9054 | St Nicholas Medical Group 5520 Santa Monica Blvd Suite 112 Los Angeles CA 90038-2932 Ph: (323) 860-9054 |
| NPI Number | 1891026100 |
|---|---|
| Provider Enumeration Date | 01/26/2010 |
| Last Update Date | 08/26/2010 |
| Medicare PECOS PAC ID | 1759423379 |
|---|---|
| Medicare Enrollment ID | O20100120000601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891026100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | A60865 (California) | Primary |
| Provider Name | Jacob N Flores |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1164469201 PECOS PAC ID: 7719960434 Enrollment ID: I20040611001036 |
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