# SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

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

## Provider details

- **NPI number:** 1689606196
- **Authorized official:** DR. RAMIN DAVIDOFF MD (EXECUTIVE MEDICAL DIRECTOR)
- **Authorized official phone:** (877) 608-0044

## Contact information

- **Practice address:** 9961 SIERRA AVE, FONTANA, CA 92335-6720
- **Practice address phone:** (909) 427-3910
- **Mailing address:** 393 E WALNUT ST, 3RD FL PHR GROUP & PROVIDER ENROLLMENT, PASADENA, CA 91188-0001
- **Mailing address phone:** (626) 405-7914
- **Mailing address fax:** (626) 405-4600

## Taxonomy

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

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 11/02/2021