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Organization
REPHANA MEDICAL GROUP
Active
Organization
REPHANA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEAL SHANBLATT MD (PRESIDENT)
(310) 451-0111
Entity
Organization
Contact information
Practice address
1304 15TH ST STE 402, SANTA MONICA, CA 90404-1813
(310) 451-0111
Mailing address
5850 W 3RD ST # 132, LOS ANGELES, CA 90036-2860
(310) 451-0111
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A64647
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A646470
—
CA
Enumeration date
02/14/2007
Last updated
08/22/2020
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