Rucker Medical Group Inc

NPI 1174801054 - Family Medicine - 207Q00000X

NPI Details
NPI 1174801054
Enumeration Date 07/27/2011
Last Updated 07/27/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name BURNETT BURNETT
Position MEDICAL DIRECTOR
Phone (323) 662-7764
Fax (323) 662-7714
Practice Location
5265 FOUNTAIN AVE
SUITE 1A
LOS ANGELES CA, 90029-1300, US
Phone (323) 662-7764
Fax (323) 662-7714
Business Location
5265 FOUNTAIN AVE
SUITE 1A
LOS ANGELES CA, 90029-1300, US
Phone (323) 662-7764
Fax (323) 662-7714
Toxanomy
Taxonomy Code 207Q00000X
License State California
License Number A34349
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According to our database, Rucker Medical Group Inc NPI is 1174801054, taxonomy code is 207Q00000X and license number is A34349, license state is located at California. Rucker Medical Group Inc physically located at 5265 Fountain Ave, Los Angeles CA, 90029-1300. NPI Number 1033115704 has the healthcare provider type.

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1174801054 NPI number is provided on an as is basis without warranty of any kind. 1174801054 is maintained by the National Plan & Provider Enumeration System. The contents of Rucker Medical Group Inc are for informational purposes only.