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San Judas Medical Group West
Specialist in Los Angeles, California
NPI 1033256573

San Judas Medical Group West is a Specialist based in Los Angeles, CA. San Judas Medical Group West practices in Los Angeles, CA. The NPI Number for San Judas Medical Group West is 1033256573 and holds a License No. A48731 (California).

The current practice location address for San Judas Medical Group West is 1080 N Western Ave, Los Angeles, CA and can be reached out via phone at 323-957-8787 and via fax at 323-957-8777.

Location: 1080 N Western Ave, Los Angeles, CA, 90029-2310
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1033256573
Provider Name
San Judas Medical Group West
Credential
Provider Entity Type
Organization
Address
1080 N Western Ave, Los Angeles, CA, 90029-2310
Phone Number
323-957-8787
Fax Number
323-957-8777
Provider Enumeration Date
02/01/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
GR0067430 05 CA
institution
Provider Business Practice Location Address Details
Address
1080 N Western Ave
City
Los Angeles
State
California
Zip
90029-2310
Phone Number
323-957-8787
Fax Number
323-957-8777
person
Provider Business Mailing Address Details
Address
1080 N Western Ave
City
Los Angeles
State
California
Zip
90029-2310
Phone Number
323-957-8787
Fax Number
323-957-8777
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
A48731 (California)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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