Provider Demographics
NPI:1841924818
Name:SHINNEL MEDICAL GROUP INC
Entity type:Organization
Organization Name:SHINNEL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAOBI
Authorized Official - Middle Name:
Authorized Official - Last Name:OZOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-564-4040
Mailing Address - Street 1:7824 BANGLE RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2620
Mailing Address - Country:US
Mailing Address - Phone:213-564-4040
Mailing Address - Fax:
Practice Address - Street 1:5155 W ROSECRANS AVE STE 220
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6663
Practice Address - Country:US
Practice Address - Phone:213-564-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty