Pacific Anti Aging Medical Group, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PACIFIC ANTI AGING MEDICAL GROUP, INC.

Practice address

215 S la Cienega Blvd Ste 207
Beverly Hills, CA 90211-3322

Phone

(310) 272-4395

Fax

(866) 284-5217

NPI assigned

Apr 2, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Landon C. McCarrollNPI 1154761518

Title

Ceo/Owner

Phone

(310) 272-4395

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Landon C. McCarroll, PA

  • Medical Physician Assistant
  • Los Angeles, CA
  • NPI 1154761518
  NPD Authorized official
• Demijon Lingad Dicen

  • Physician Assistant
  • Beverly Hills, CA
  • NPI 1528726429
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1144782939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 S LA CIENEGA BLVD STE 207",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113322",
            "telephone_number": "310-272-4395",
            "fax_number": "866-284-5217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 S LA CIENEGA BLVD STE 207",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113322",
            "telephone_number": "310-272-4395",
            "fax_number": "866-284-5217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC ANTI AGING MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "MCCARROLL",
        "authorized_official_first_name": "LANDON",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "310-272-4395"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.