Basic Information
| Provider Information | |||||||||
| NPI: | 1053082586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIPELINE COMMUNITY SPECIALTY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 898 N PACIFIC COAST HWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902452747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103792134 | ||||||||
| FaxNumber: | 3103794856 | ||||||||
| Practice Location | |||||||||
| Address1: | 1141 W REDONDO BEACH BLVD STE 212 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902473584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106985463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3103560515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.