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Prairie Medical Group
Specialist in Marina Del Rey, California
NPI 1194846410

Prairie Medical Group is a Specialist based in Los Angeles, CA. Prairie Medical Group practices in Marina Del Rey, CA. The NPI Number for Prairie Medical Group is 1194846410 and holds a License No. 058963 (California).

The current practice location address for Prairie Medical Group is 4644 Lincoln Blvd, Marina Del Rey, CA and can be reached out via phone at 310-214-8677 and via fax at 310-921-1718.

Location: 4644 Lincoln Blvd, Marina Del Rey, CA, 90084
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1194846410
Provider Name
Prairie Medical Group
Credential
Provider Entity Type
Organization
Address
4644 Lincoln Blvd, Marina Del Rey, CA, 90084
Phone Number
310-214-8677
Fax Number
310-921-1718
Provider Enumeration Date
04/03/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
GR0078675 05 CA
institution
Provider Business Practice Location Address Details
Address
4644 Lincoln Blvd
City
Marina Del Rey
State
California
Zip
90292
Phone Number
310-214-8677
Fax Number
310-921-1718
person
Provider Business Mailing Address Details
Address
4644 Lincoln Blvd
City
Marina Del Rey
State
California
Zip
90292
Phone Number
310-214-8677
Fax Number
310-921-1718
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
058963 (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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