Organization
YOUR COMMUNITY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL LEROY MCMILLAN M.D., (OWNER)
(562) 928-9700
Entity
Organization
Contact information
Practice address
6300 FLORENCE AVE, BELL GARDENS, CA 90201-8900
(562) 928-9700
(562) 928-8300
Mailing address
6300 FLORENCE AVE, BELL GARDENS, CA 90201-8900
(562) 928-9700
(562) 928-8300
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
C39834
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C398340
—
CA
05
—
00C398341
—
CA
01
—
C39834
STATE LIC NUMBER
CA
Enumeration date
03/22/2011
Last updated
03/22/2011
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