Provider Demographics
NPI:1073228177
Name:HOUSECALL MD MEDICAL PRACTICE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HOUSECALL MD MEDICAL PRACTICE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE AND LEGAL EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:TAREVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:757-768-9126
Mailing Address - Street 1:1968 S COAST HWY # 1469
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:833-432-5633
Mailing Address - Fax:833-265-2088
Practice Address - Street 1:2051 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1373
Practice Address - Country:US
Practice Address - Phone:833-432-5633
Practice Address - Fax:833-265-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty