Provider Demographics
NPI:1689939787
Name:CEDARS TOWER MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CEDARS TOWER MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-606-3888
Mailing Address - Street 1:8631 W 3RD ST STE 1140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5965
Mailing Address - Country:US
Mailing Address - Phone:323-712-1411
Mailing Address - Fax:818-506-9030
Practice Address - Street 1:8631 W 3RD ST STE 1140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5965
Practice Address - Country:US
Practice Address - Phone:323-712-1411
Practice Address - Fax:818-506-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21671363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty