NPIMap

Organization Active NPI

Lifespan Medicine

  • Adult Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1417271750
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
20A6324 Issued in CA
Legal business name
LIFESPAN MEDICINE
Practice address
2811 Wilshire Blvd
Suite 610
Santa Monica, CA 90403-4803
Phone
(310) 453-2335
NPI assigned
Mar 16, 2010
Last updated
Mar 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

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

Authorized official

Name
Gina Renna
Title
Ceo
Phone
(310) 453-2335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 20A6324 CA Primary

Addresses

Primary practice location

2811 Wilshire Blvd
Suite 610
Santa Monica, CA 90403-4803

Mailing address

2811 Wilshire Blvd
Suite 610
Santa Monica, CA 90403-4803
Phone (310) 453-2335

National Provider Directory

National Provider Directory
Tax ID family
Lifespan Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1417271750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 WILSHIRE BLVD",
            "address_2": "SUITE 610",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034803",
            "telephone_number": "310-453-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 WILSHIRE BLVD",
            "address_2": "SUITE 610",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034803",
            "telephone_number": "310-453-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "RENNA",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-453-2335"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "20A6324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; 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.