# RONALD A CARLISH MEDICAL GROUP

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

## Provider details

- **NPI number:** 1790094639
- **Authorized official:** DR. RONALD A CARLISH M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (213) 977-9421

## Contact information

- **Practice address:** 1127 WILSHIRE BLVD, STE 820, LOS ANGELES, CA 90017-3910
- **Practice address phone:** (213) 977-9421
- **Practice address fax:** (213) 977-9422
- **Mailing address:** 1127 WILSHIRE BLVD, STE 820, LOS ANGELES, CA 90017-3910
- **Mailing address phone:** (213) 977-9421
- **Mailing address fax:** (213) 977-9422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | G15424 | CA | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | G15424 | CA | Yes |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | A64244 | CA | — |

## Other

- **Enumeration date:** 09/27/2010
- **Last updated:** 01/27/2011