| Organization Name: | MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC |
| NPI Number: | 1083643837 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LEMMON C MCMILLAN (PRESIDENT) |
| Mailing Address: | 1704 W Manchester Ave Suite 101 Los Angeles |
| State: | CA US |
| Postal Code: | 900473034 |
| Phone Number: | 3237786215 |
| Fax Number: | 3237786312 |
| NPI Enumeration Date: | 07/02/2006 |
| NPI Last Update Date: | 12/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |