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
2103 E GONZALES RD, OXNARD, CA 93036-3757
(805) 650-4700
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
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275756652
—
CA
Enumeration date
04/11/2007
Last updated
05/27/2021
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