Organization Active NPI

Lax Physical Medicine, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Los Angeles, CA
National Provider Identifier
1386084846
Registry record updated Aug 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
A101415 Issued in CA
Legal business name
LAX PHYSICAL MEDICINE, INC.
Practice address
9100 S Sepulveda Blvd
Suite 104
Los Angeles, CA 90045-4849
Phone
(310) 670-9999
Fax
(310) 670-9994
NPI assigned
Jun 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2013

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

Authorized official

Name
Dr. Shelley McDonald, MD
Title
President
Phone
(310) 670-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X A101415 CA Primary

Addresses

Primary practice location

9100 S Sepulveda Blvd
Suite 104
Los Angeles, CA 90045-4849

Mailing address

9100 S Sepulveda Blvd
Suite 104
Los Angeles, CA 90045-4849
Phone (310) 670-9999

National Provider Directory

National Provider Directory

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": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375401600000",
    "number": "1386084846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9100 S SEPULVEDA BLVD",
            "address_2": "SUITE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454849",
            "telephone_number": "310-670-9999",
            "fax_number": "310-670-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 S SEPULVEDA BLVD",
            "address_2": "SUITE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454849",
            "telephone_number": "310-670-9999",
            "fax_number": "310-670-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAX PHYSICAL MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-08-02",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-670-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A101415",
            "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 Aug 2, 2013; 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.