Organization
CONCENTRA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL DAVIS (CREDENTIALING SUPPORT SPECIALIST)
(972) 364-8083
Entity
Organization
Contact information
Practice address
4306 DUQUESNE AVE, CULVER CITY, CA 90232-2957
(410) 608-7988
Mailing address
4306 DUQUESNE AVE, CULVER CITY, CA 90232-2957
(410) 608-7988
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A119899
CA
Other
Enumeration date
05/03/2014
Last updated
05/03/2014
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