CHOICE PROVIDERS MEDICAL GROUP INC

Provider Demographics

• NPI: 1114947058
• Name: CHOICE PROVIDERS MEDICAL GROUP INC
• Entity Type: Organization
• Organization Name: CHOICE PROVIDERS MEDICAL GROUP INC
• Other - Org Name: NOBLE COMMUNITY MEDICAL ASSOCAITES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: SECRETARY
• Authorized Official - Prefix: DR
• Authorized Official - First Name: HANY
• Authorized Official - Last Name: MALEK
• Authorized Official - Credentials: DC
• Authorized Official - Phone: 818-705-7200
• Mailing Address - Street 1: 17750 SHERMAN WAY
• Mailing Address - Street 2: STE 101
• Mailing Address - City: RESEDA
• Mailing Address - State: CA
• Mailing Address - Zip Code: 91335-3380
• Mailing Address - Country: US
• Mailing Address - Phone: 818-705-7200
• Mailing Address - Fax: 818-343-0805
• Practice Address - Street 1: 17750 SHERMAN WAY
• Practice Address - Street 2: STE 101
• Practice Address - City: RESEDA
• Practice Address - State: CA
• Practice Address - Zip Code: 91335-3380
• Practice Address - Country: US
• Practice Address - Phone: 818-705-7200
• Practice Address - Fax: 818-343-0805
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-21
• Last Update Date: 2008-05-29

Provider Licenses

State	License ID	Taxonomies
CA	DC21916	111N00000X
CA	DC28504	111N00000X
CA	DC20140	111N00000X
CA	DC20098	111N00000X
CA	173F00000X	173F00000X
CA	A36588	207Q00000X
CA	A35585	207Q00000X
CA	A64420	207R00000X
CA	A44927	207R00000X
CA	C30241	207X00000X
CA	C31379	207X00000X
CA	A25062	208000000X
CA	A54207	208000000X
CA	G78404	208VP0000X
CA	PA13428	363A00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	111N00000X	Chiropractic Providers	Chiropractor		Group - Multi-Specialty
No	173F00000X	Other Service Providers	Sleep Specialist, PhD		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	208VP0000X	Allopathic & Osteopathic Physicians	Pain Medicine	Pain Medicine	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	ZZZ50145Z	Other	BLUE SHEILD (RESEDA)
CA	ZZZ50147Z	Other	BLUE SHEILD (INGLEWOOD)
CA	ZZZ50174Z	Other	BLUE SHEILD (S.B.)
CA	ZZZ50176Z	Other	BLUE SHEILD (C.P)
CA	ZZZ501722Z	Other	BLUE SHEILD (G.H.)
CA	ZZZ50172Z	Other	BLUE SHEILD (EL MONTE)
CA	ZZZ50173Z	Other	BLUE SHEILD (PASADENA)
CA	GR0102431	Medicaid
CA	GR0102433	Medicaid
CA	ZZZ50146Z	Other	BLUE SHEILD (L.A.)
CA	GR0102434	Medicaid
CA	ZZZ501752	Other	BLUE SHEILD
CA	GR0102430	Medicaid
CA	GR0102432	Medicaid
CA	GR0102430	Medicaid