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Organization
MEDIPRO INC.
Active
Organization
MEDIPRO INC.
Active
Other names
Mediplus Multispeciality Medical Grp.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH EMANUEL PIERSON III M.D. (CEO/PRESIDENT)
(323) 730-0310
Entity
Organization
Contact information
Practice address
1828 S WESTERN AVE, SUITE 10, LOS ANGELES, CA 90006-5808
(323) 730-0310
(323) 735-2743
Mailing address
1828 S WESTERN AVE, SUITE 10, LOS ANGELES, CA 90006-5808
(323) 730-0310
(323) 735-2743
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G53815
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G53815
PROVIDER MEDICAL LICENSE
CA
05
—
GR0063270
—
CA
05
—
GR0063272
—
CA
Enumeration date
06/01/2006
Last updated
08/22/2020
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