Provider Demographics
NPI:1679945695
Name:SOCAL MEDICAL GROUP
Entity type:Organization
Organization Name:SOCAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-364-6489
Mailing Address - Street 1:6053 BRISTOL PKWY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6601
Mailing Address - Country:US
Mailing Address - Phone:323-364-6489
Mailing Address - Fax:800-729-8207
Practice Address - Street 1:8207 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1132
Practice Address - Country:US
Practice Address - Phone:800-724-8207
Practice Address - Fax:800-729-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35886103TA0400X
CA66975207QA0401X
CA1364752084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty