Provider Demographics
NPI:1952068777
Name:COMMONS CLINIC MEDICAL NETWORK, PC
Entity type:Organization
Organization Name:COMMONS CLINIC MEDICAL NETWORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-628-1009
Mailing Address - Street 1:2708 WILSHIRE BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4706
Mailing Address - Country:US
Mailing Address - Phone:310-753-0932
Mailing Address - Fax:
Practice Address - Street 1:13160 MINDANAO WAY STE 300
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6393
Practice Address - Country:US
Practice Address - Phone:415-687-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty