# JAGA MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356898357
- **Authorized official:** DR. ARDIENNE ANN GRANT D.O. (PRESIDENT)
- **Authorized official phone:** (323) 999-2250

## Contact information

- **Practice address:** 1400 COLORADO BLVD, A, EAGLE ROCK, CA 90041-2321
- **Practice address phone:** (323) 999-2250
- **Practice address fax:** (323) 999-2241
- **Mailing address:** 1400 COLORADO BLVD, A, EAGLE ROCK, CA 90041-2321
- **Mailing address phone:** (323) 999-2250
- **Mailing address fax:** (323) 999-2241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 20A7285 | CA | Yes |

## Other

- **Enumeration date:** 09/07/2016
- **Last updated:** 10/20/2016