Provider Demographics
NPI:1770034290
Name:TRI-L MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TRI-L MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESSIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-275-8377
Mailing Address - Street 1:415 N CRESCENT DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4860
Mailing Address - Country:US
Mailing Address - Phone:310-275-8377
Mailing Address - Fax:
Practice Address - Street 1:415 N CRESCENT DR
Practice Address - Street 2:SUITE 140
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4860
Practice Address - Country:US
Practice Address - Phone:310-275-8377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104439282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital