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Organization
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Active
Organization
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMIN DAVIDOFF M.D. (EXECUTIVE MEDICAL DIRECTOR)
(877) 608-0044
Entity
Organization
Contact information
Practice address
1011 BALDWIN PARK BLVD, BALDWIN PARK, CA 91706-5806
(626) 851-1011
Mailing address
393 E WALNUT ST, 3RD FL PHR GROUP & PROVIDER ENROLLMENT, PASADENA, CA 91188-0001
(626) 405-7914
(626) 405-4600
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
NULL
Other
Enumeration date
07/07/2006
Last updated
10/01/2021
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