Provider Demographics
NPI:1477932267
Name:HIGH-TEC MULTISPECIALTY MEDICAL GROUP
Entity Type:Organization
Organization Name:HIGH-TEC MULTISPECIALTY MEDICAL GROUP
Other - Org Name:CENTRO HIGH-TEC DE ESPECIALIDADES MULTIPLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-209-1177
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5498
Mailing Address - Country:US
Mailing Address - Phone:310-289-8678
Mailing Address - Fax:323-978-5163
Practice Address - Street 1:5301 WHITTIER BLVD FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4043
Practice Address - Country:US
Practice Address - Phone:310-289-8678
Practice Address - Fax:323-978-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3769329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty