South Los Angeles Medical Group Professional Corporation

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

SOUTH LOS ANGELES MEDICAL GROUP PROFESSIONAL CORPORATION

Practice address

2804 W Florence Ave
Los Angeles, CA 90043-5142

Phone

(323) 807-2980

NPI assigned

Jun 19, 2026

Organization subpart

No

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

Authorized official

Name

Jenny Lopez

Title

Office Manager

Phone

(562) 832-6380

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1781827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1538095385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 W FLORENCE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900435142",
            "telephone_number": "323-807-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 W FLORENCE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900435142",
            "telephone_number": "323-807-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LOS ANGELES MEDICAL GROUP PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-19",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "562-832-6380"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Central Residential Care #2
• South Coast Diagnostic Medical Group
• South Fork Healthcare, LLC
• South Healthcare Center LLC
• South la Eye Clinic
• South Oc Open Arms
• South Western Pharmacy
• South Western Pharmacy
• Bienville South
• Reginald John Southall III

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; 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.