Provider Demographics
NPI:1659432409
Name:JRHEEMD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JRHEEMD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-777-2469
Mailing Address - Street 1:520 S VIRGIL AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1425
Mailing Address - Country:US
Mailing Address - Phone:714-777-2469
Mailing Address - Fax:310-329-0176
Practice Address - Street 1:520 S VIRGIL AVE STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1425
Practice Address - Country:US
Practice Address - Phone:714-777-2469
Practice Address - Fax:714-917-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA923452081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22397AMedicare PIN