Organization
JAGA MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARDIENNE ANN GRANT D.O. (PRESIDENT)
(323) 999-2250
Entity
Organization
Contact information
Practice address
1400 COLORADO BLVD, A, EAGLE ROCK, CA 90041-2321
(323) 999-2250
(323) 999-2241
Mailing address
1400 COLORADO BLVD, A, EAGLE ROCK, CA 90041-2321
(323) 999-2250
(323) 999-2241
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20A7285
CA
Other
Enumeration date
09/07/2016
Last updated
10/20/2016
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