Organization
VENICE CULVER MARINA MEDICAL GROUP INC
Active
Organization
VENICE CULVER MARINA MEDICAL GROUP INC
Active
Parent organization
VENICE CULVER MARINA MEDICAL GROUP INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
VENICE CULVER MARINA MEDICAL GROUP INC
Authorized official
MR. JAY TEHRANI BILLING MANAGER (BILLING MANAGER)
(310) 672-9000
Entity
Organization
Contact information
Practice address
12212 W WASHINGTON BLVD, LOS ANGELES, CA 90066
(310) 391-5241
(310) 397-4324
Mailing address
PO BOX 24706, LOS ANGELES, CA 90024
(310) 391-5241
(310) 397-4324
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
A32561
CA
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
02/12/2008
Last updated
10/10/2017
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