Organization
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMIN DAVIDOFF M.D. (EXECUTIVE MEDICAL DIRECTOR)
(877) 608-0044
Entity
Organization
Contact information
Practice address
4580 ELECTRONICS PL, LOS ANGELES, CA 90039-1008
(818) 502-5141
Mailing address
393 E WALNUT ST, 3RD FLOOR PHR GROUP & PROVIDER ENROLLMENT, PASADENA, CA 91188-0001
(626) 405-7914
(626) 405-4600
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
03/12/2009
Last updated
11/02/2021
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