Organization
EAGAN CONCIERGE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREANNA SPLAIN (DIRECTOR OF CREDENTIALING)
(760) 835-6880
Entity
Organization
Contact information
Practice address
2658 GRIFFITH PARK BLVD STE 305, LOS ANGELES, CA 90039-2520
(310) 702-9803
Mailing address
2658 GRIFFITH PARK BLVD STE 305, LOS ANGELES, CA 90039-2520
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
04/26/2021
Last updated
04/26/2021
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