Provider Demographics
NPI:1962008003
Name:VIP MEDICAL CONCIERGE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VIP MEDICAL CONCIERGE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-395-3060
Mailing Address - Street 1:1236 E HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1412
Mailing Address - Country:US
Mailing Address - Phone:818-813-2273
Mailing Address - Fax:
Practice Address - Street 1:4560 ADMIRALTY WAY STE 200B
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5425
Practice Address - Country:US
Practice Address - Phone:818-813-2273
Practice Address - Fax:818-471-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty