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Organization
MTBLO MEDICAL GROUP INC
Active
Organization
MTBLO MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GITTER MD (OWNER/AUTHORIZED OFFICIAL)
(213) 385-0675
Entity
Organization
Contact information
Practice address
540 N MONTEBELLO BLVD STE D, MONTEBELLO, CA 90640
(323) 728-0080
(323) 728-0090
Mailing address
PO BOX 27206, LOS ANGELES, CA 90027-0206
(213) 385-0675
(213) 365-6429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316241946
GROUP NPI
CA
Enumeration date
12/22/2010
Last updated
01/20/2021
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