Organization
MEDICAL GROUP ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN RICHARD JACOBS M.D. (PRECIDENT)
(310) 652-2255
Entity
Organization
Contact information
Practice address
8501 WILSHIRE BLVD, 316, BEVERLY HILLS, CA 90211-3101
(310) 652-2255
(310) 652-3580
Mailing address
8501 WILSHIRE BLVD, 316, BEVERLY HILLS, CA 90211-3101
(310) 652-2255
(310) 652-3580
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
C27493
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0006640
—
CA
01
—
ZZZ87633Z
BLUE SHIELD
CA
Enumeration date
11/01/2006
Last updated
09/25/2008
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