Organization
PERFORMANCE HEALTH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN D CARRICO DC (OWNER)
(310) 540-9699
Entity
Organization
Contact information
Practice address
13252 GARDEN GROVE BLVD, SUITE 112, GARDEN GROVE, CA 92843-2204
(714) 740-1778
(714) 740-1913
Mailing address
21707 HAWTHORNE BLVD, STE 201, TORRANCE, CA 90503
(310) 540-9699
(310) 540-9486
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18860A
MEDICARE
CA
Enumeration date
01/31/2007
Last updated
04/22/2009
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