Provider Demographics
NPI:1962862110
Name:LOS ANGELES JEWISH HOME IPA
Entity Type:Organization
Organization Name:LOS ANGELES JEWISH HOME IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOACHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-774-3032
Mailing Address - Street 1:7150 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3700
Mailing Address - Country:US
Mailing Address - Phone:818-774-3000
Mailing Address - Fax:818-757-4401
Practice Address - Street 1:7150 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3700
Practice Address - Country:US
Practice Address - Phone:818-774-3000
Practice Address - Fax:818-757-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty