Provider Demographics
NPI:1356843221
Name:COMPLETE HEALTH MEDG
Entity Type:Organization
Organization Name:COMPLETE HEALTH MEDG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VON HUGGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-522-4402
Mailing Address - Street 1:3501 JACK NORTHROP AVE STE 11729
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4433
Mailing Address - Country:US
Mailing Address - Phone:323-522-4402
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 452
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6361
Practice Address - Country:US
Practice Address - Phone:323-522-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA00048842083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty