| |
644 E Regent St Ste. 100 Inglewood CA 90301-1433 | |
(310) 674-3807 | |
(310) 674-3810 |
Full Name | |
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Speciality | Internal Medicine |
Location | 644 E Regent St, Inglewood, California |
Authorized Official Name and Position | John G. Liethen (SECRETARY) |
Authorized Official Contact | 9522056262 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P.o. Box 6400 Torrance CA 90504-6400 Ph: (310) 674-3807 | 644 E Regent St Ste. 100 Inglewood CA 90301-1433 Ph: (310) 674-3807 |
NPI Number | 1740308717 |
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Provider Enumeration Date | 03/27/2007 |
Last Update Date | 08/19/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740308717 | NPI | - | NPPES |
033021 | Other | CA | BUSINESS LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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