Provider Demographics
NPI:1083946180
Name:PLATINUM MEDICAL GROUP
Entity Type:Organization
Organization Name:PLATINUM MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-402-2818
Mailing Address - Street 1:27762 ANTONIO PKWY STE L1-433
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1140
Mailing Address - Country:US
Mailing Address - Phone:562-402-2818
Mailing Address - Fax:562-402-2545
Practice Address - Street 1:21520 PIONEER BLVD STE 203
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2601
Practice Address - Country:US
Practice Address - Phone:562-402-2818
Practice Address - Fax:562-402-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty