Organization
ST. MARY IPA
Active
Parent organization
LAKEWOOD IPA, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKEWOOD IPA, INC.
Authorized official
MRS. CHRISTEN REYNOLDS MBA (DIRECTOR OF FINANCE)
(562) 602-1563
Entity
Organization
Contact information
Practice address
4909 LAKEWOOD BLVD, STE. 200, LAKEWOOD, CA 90712-2405
(562) 602-1563
(562) 531-0937
Mailing address
4909 LAKEWOOD BLVD, STE. 200, LAKEWOOD, CA 90712-2405
(562) 602-1563
(562) 531-0937
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
011549
CA
Other
Enumeration date
06/22/2006
Last updated
10/16/2012
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