Provider Demographics
NPI:1538952544
Name:AE PROFESSIONAL MEDICAL GROUP CORPORATION
Entity type:Organization
Organization Name:AE PROFESSIONAL MEDICAL GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANLAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-754-7986
Mailing Address - Street 1:1600 ROSECRANS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3708
Mailing Address - Country:US
Mailing Address - Phone:818-754-7986
Mailing Address - Fax:
Practice Address - Street 1:1600 ROSECRANS AVE BLDG 7 STE 400
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3708
Practice Address - Country:US
Practice Address - Phone:818-754-7986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty