Provider Demographics
NPI:1548506504
Name:SOUTHERN CALIFORNIA MEDICAL GROUP
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-749-5386
Mailing Address - Street 1:3320 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-4119
Mailing Address - Country:US
Mailing Address - Phone:213-749-5386
Mailing Address - Fax:213-749-8592
Practice Address - Street 1:3320 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-4119
Practice Address - Country:US
Practice Address - Phone:213-749-5386
Practice Address - Fax:213-749-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty