Organization
RONALD A CARLISH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD A CARLISH M.D. (MEDICAL DIRECTOR)
(213) 977-9421
Entity
Organization
Contact information
Practice address
1127 WILSHIRE BLVD, STE 820, LOS ANGELES, CA 90017-3910
(213) 977-9421
(213) 977-9422
Mailing address
1127 WILSHIRE BLVD, STE 820, LOS ANGELES, CA 90017-3910
(213) 977-9421
(213) 977-9422
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G15424
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
G15424
CA
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
A64244
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G15424
STATE LICENSE
CA
Enumeration date
09/27/2010
Last updated
01/27/2011
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