Provider Demographics
NPI:1104205400
Name:RESIDENTIALIST HOUSECALL MED GRP, PC A PENNSYLVANIA CORP
Entity Type:Organization
Organization Name:RESIDENTIALIST HOUSECALL MED GRP, PC A PENNSYLVANIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VINN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-366-1053
Mailing Address - Street 1:23181 VERDUGO DR
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1357
Mailing Address - Country:US
Mailing Address - Phone:949-366-1053
Mailing Address - Fax:949-544-7880
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:PCOM - ROWLAND HALL, ROOM 528
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:949-366-1053
Practice Address - Fax:949-544-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017618207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty