Provider Demographics
NPI:1609403807
Name:DOCTORS ON THE GO PROFESSIONAL GROUP CORP.
Entity Type:Organization
Organization Name:DOCTORS ON THE GO PROFESSIONAL GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:SARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-321-4421
Mailing Address - Street 1:3325 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1718
Mailing Address - Country:US
Mailing Address - Phone:213-465-2643
Mailing Address - Fax:213-232-4944
Practice Address - Street 1:3450 WILSHIRE BLVD STE 1118
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2227
Practice Address - Country:US
Practice Address - Phone:213-465-2643
Practice Address - Fax:213-232-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty