Provider Demographics
NPI:1134669971
Name:CARE CONNECT MEDICAL GROUP
Entity Type:Organization
Organization Name:CARE CONNECT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-823-5980
Mailing Address - Street 1:3111 LOS FELIZ BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1585
Mailing Address - Country:US
Mailing Address - Phone:866-227-3310
Mailing Address - Fax:866-491-1305
Practice Address - Street 1:3111 LOS FELIZ BLVD
Practice Address - Street 2:STE 211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1585
Practice Address - Country:US
Practice Address - Phone:866-227-3310
Practice Address - Fax:866-491-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty