Provider Demographics
NPI:1922351303
Name:MEDICAL PLAZA OF SAN PEDRO INC.
Entity Type:Organization
Organization Name:MEDICAL PLAZA OF SAN PEDRO INC.
Other - Org Name:SAN PEDRO FAMILY AND URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHSINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-250-1680
Mailing Address - Street 1:2537 PACIFIC COAST HWY STE B
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7064
Mailing Address - Country:US
Mailing Address - Phone:424-250-1680
Mailing Address - Fax:424-250-1580
Practice Address - Street 1:529 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3115
Practice Address - Country:US
Practice Address - Phone:310-831-1535
Practice Address - Fax:310-872-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101847207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty