Provider Demographics
NPI:1255400032
Name:JOSEPH M PAGE MD INCORPORATION
Entity type:Organization
Organization Name:JOSEPH M PAGE MD INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-207-5030
Mailing Address - Street 1:1711 W TEMPLE ST FL 7
Mailing Address - Street 2:SUITE 7606
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-207-5030
Mailing Address - Fax:213-273-8391
Practice Address - Street 1:1711 W TEMPLE ST FL 7
Practice Address - Street 2:SUITE 7606
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-207-5030
Practice Address - Fax:213-273-8391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH M PAGE MD INCORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15136207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA009151360OtherBLUE CROSS BLUE SHIELD
CA00G15136Medicaid
CACW347AMedicare PIN
CA915136Medicare ID - Type Unspecified
CA00G15136Medicaid
A39445Medicare UPIN