Provider Demographics
NPI:1518716240
Name:SPECIALTY MEDICAL GROUP CA PC
Entity type:Organization
Organization Name:SPECIALTY MEDICAL GROUP CA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-685-8837
Mailing Address - Street 1:1230 ROSECRANS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2494
Mailing Address - Country:US
Mailing Address - Phone:310-878-6978
Mailing Address - Fax:
Practice Address - Street 1:1230 ROSECRANS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2494
Practice Address - Country:US
Practice Address - Phone:310-878-6978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty