# SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Target Clinic Medical Associates of Southern California
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336556059
- **Authorized official:** DR. RAMIN DAVIDOFF M.D. (EXECUTIVE MEDICAL DIRECTOR)
- **Authorized official phone:** (877) 608-0044

## Contact information

- **Practice address:** 1893 W MALVERN AVE, FULLERTON, CA 92833-2403
- **Practice address phone:** (877) 608-0044
- **Mailing address:** 393 E WALNUT ST, PROVIDER ENROLLMENT, 3RD FLOOR, PASADENA, CA 91188-0001
- **Mailing address phone:** (877) 608-0044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 07/15/2014
- **Last updated:** 11/02/2021