| Wellcare La Medical Group | |
|
16415 S Colorado Avenue Suite 208 Paramount CA 90723-5054 | |
| (562) 531-0015 | |
| (562) 531-4856 |
| Full Name | Wellcare La Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 16415 S Colorado Avenue, Paramount, California |
| Authorized Official Name and Position | Richard W Lee (PHYSICIAN) |
| Authorized Official Contact | 5625310015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellcare La Medical Group 16415 S Colorado Avenue Suite 208 Paramount CA 90723-5054 Ph: (562) 531-0015 | Wellcare La Medical Group 16415 S Colorado Avenue Suite 208 Paramount CA 90723-5054 Ph: (562) 531-0015 |
| NPI Number | 1225314107 |
|---|---|
| Provider Enumeration Date | 10/24/2011 |
| Last Update Date | 01/31/2013 |
| Medicare PECOS PAC ID | 3072789981 |
|---|---|
| Medicare Enrollment ID | O20111227000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225314107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (California) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | A85452 (California) | Primary |
| Provider Name | Richard W Lee |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1780761353 PECOS PAC ID: 3870573496 Enrollment ID: I20040723000674 |
| Provider Name | Yang W Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326241696 PECOS PAC ID: 6406937150 Enrollment ID: I20080118000493 |
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