Organization Name: | PARKLANE MEDICAL GROUP |
NPI Number: | 1336355320 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGE C IFEORAH (DIRECTOR) |
Mailing Address: | 508 North Long Beach Bl. Compton |
State: | CA US |
Postal Code: | 90221 |
Phone Number: | 3106373989 |
Fax Number: | 3106379325 |
NPI Enumeration Date: | 05/15/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |