Active NPI
Ageless Men'S Health Ca PC
- Internal Medicine Physician
- Los Angeles, CA
National Provider Identifier
1245561828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- PA13875
- Legal business name
- AGELESS MEN'S HEALTH CA PC
- Practice address
- 11633 San Vincente Blvd
Suite 214
Los Angeles, CA 90049 - Phone
- (310) 979-8378
- Fax
- (310) 979-8379
- NPI assigned
- Jan 21, 2010
- Organization subpart
- Yes
- Parent organization
- AGELESS MEN'S HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amanda Wilkinson
- Title
- Business Operations Director
- Phone
- (702) 818-0446
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | PA13875 | CA | Primary |
Addresses
Primary practice location
11633 San Vincente Blvd
Suite 214
Los Angeles, CA 90049
Mailing address
11633 San Vincente Blvd
Suite 214
Los Angeles, CA 90049
Phone (310) 979-8378
National Provider Directory
National Provider Directory- Part of
- Ageless Men'S Health LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Specialist
- San Francisco, CA
- NPI 1124451299
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Santa Barbara, CA
- NPI 1093933756
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264032000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731283200000",
"number": "1245561828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11633 SAN VINCENTE BLVD",
"address_2": "SUITE 214",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-979-8378",
"fax_number": "310-979-8379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11633 SAN VINCENTE BLVD",
"address_2": "SUITE 214",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-979-8378",
"fax_number": "310-979-8379"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AGELESS MEN'S HEALTH CA PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AGELESS MEN'S HEALTH",
"enumeration_date": "2010-01-21",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A",
"authorized_official_last_name": "WILKINSON",
"authorized_official_first_name": "AMANDA",
"authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
"authorized_official_telephone_number": "702-818-0446"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "CA",
"license": "PA13875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.