| Organization Name: | SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP |
| NPI Number: | 1336556059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD M ELLISON (EXECUTIVE MEDICAL DIRECTOR) |
| Mailing Address: | 1893 W Malvern Ave Fullerton |
| State: | CA US |
| Postal Code: | 928332403 |
| Phone Number: | 8776080044 |
| Fax Number: | |
| NPI Enumeration Date: | 07/15/2014 |
| NPI Last Update Date: | 10/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |