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Organization

LOS ANGELES MULTISPECIALTY MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RANDALL WHITAKER MAXEY MD (PRESIDENT)
(310) 680-1810
Entity
Organization

Contact information

Practice address
248 N LOCUST ST, INGLEWOOD, CA 90301-1258
(310) 680-1810
(310) 680-1811
Mailing address
PO BOX 83246, LOS ANGELES, CA 90083-0246
(310) 680-1810
(310) 680-1811

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C38014
CA
207RN0300X
Nephrology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C30814
MED LICENCE
CA
Enumeration date
01/24/2007
Last updated
03/25/2008
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