St Nicholas Medical Group

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

A60865 Issued in CA

Legal business name

ST NICHOLAS MEDICAL GROUP

Practice address

5520 Santa Monica Blvd
Suite 112
Los Angeles, CA 90038-2932

Phone

(323) 860-9054

Fax

(323) 860-9053

NPI assigned

Jan 26, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Jacob N Flores, MD

Title

Partner

Phone

(323) 860-9054

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1891026100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5520 SANTA MONICA BLVD",
            "address_2": "SUITE 112",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900382932",
            "telephone_number": "323-860-9054",
            "fax_number": "323-860-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5520 SANTA MONICA BLVD",
            "address_2": "SUITE 112",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900382932",
            "telephone_number": "323-860-9054",
            "fax_number": "323-860-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST NICHOLAS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "323-860-9054",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A60865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St John Medical Associates
• Antoinette Maria St John
• Maie Abdul-Rahman St John, MD
• Sherley St Juste
• Jeromiah St Louis
• St Nicholas Medical Group
• Kimberly St Romain
• St Vincent Medical Center
• St Vincent Medical Center
• St Vincent Preventative Family Care

• Geriatric Medicine (Internal Medicine) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.