Provider Demographics
NPI:1992866230
Name:CALIFORNIA ALLERGY & ASTHMA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CALIFORNIA ALLERGY & ASTHMA MEDICAL GROUP INC
Other - Org Name:CALIFORNIA ALLERGY & ASTHMA MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3109-669-0022
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1155
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-966-9022
Mailing Address - Fax:310-966-9042
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1155
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-966-9022
Practice Address - Fax:310-966-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW14483207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14483OtherLICENSE