NPIMap

Organization Active NPI

Venice Culver Marina Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1376711440
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
A32561 Issued in CA
Legal business name
VENICE CULVER MARINA MEDICAL GROUP INC
Practice address
12212 W Washington Blvd
Los Angeles, CA 90066
Phone
(310) 391-5241
Fax
(310) 397-4324
NPI assigned
Feb 12, 2008
Organization subpart
Yes
Parent organization
VENICE CULVER MARINA MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Authorized official

Name
Mr. Jay Tehrani, BILLING MANAGER
Title
Billing Manager
Phone
(310) 672-9000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Multi-Specialty Clinic/Center 261QM1300X A32561 CA Primary

Addresses

Primary practice location

12212 W Washington Blvd
Los Angeles, CA 90066

Mailing address

PO Box 24706
Los Angeles, CA 90024
Phone (310) 391-5241

National Provider Directory

National Provider Directory
Part of
Venice Culver Marina Me

Locations

12095 W Washington Blvd
#105
Los Angeles, CA 90066
Phone (310) 391-5241

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1376711440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24706",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90024",
            "telephone_number": "310-391-5241",
            "fax_number": "310-397-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12212 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90066",
            "telephone_number": "310-391-5241",
            "fax_number": "310-397-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENICE CULVER MARINA MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VENICE CULVER MARINA MEDICAL GROUP INC",
        "enumeration_date": "2008-02-12",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "TEHRANI",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "310-672-9000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BILLING MANAGER"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A32561",
            "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 Oct 10, 2017; 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.