Organization Name: | YOUR COMMUNITY MEDICAL GROUP INC |
NPI Number: | 1558660126 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAMUEL LEROY MCMILLAN (OWNER) |
Mailing Address: | 6300 Florence Ave Bell Gardens |
State: | CA US |
Postal Code: | 902018900 |
Phone Number: | 5629289700 |
Fax Number: | 5629288300 |
NPI Enumeration Date: | 03/22/2011 |
NPI Last Update Date: | 03/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | C39834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |