Provider Demographics
NPI:1235751405
Name:SOUTHERN CALIFORNIA PHYSICIAN ASSISTANT MEDICAL GROUP PC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PHYSICIAN ASSISTANT MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:805-732-9712
Mailing Address - Street 1:8610 S SEPULVEDA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4011
Mailing Address - Country:US
Mailing Address - Phone:818-290-3680
Mailing Address - Fax:
Practice Address - Street 1:8610 S SEPULVEDA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4011
Practice Address - Country:US
Practice Address - Phone:818-290-3680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty