Basic Information
| Provider Information | |||||||||
| NPI: | 1174591259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEDICAL GROUP OF DOWNEY, INC. | ||||||||
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| OtherOrganizationName: | COMMUNITY MEDICAL GROUP OF DOWNEY,INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10800 PARAMOUNT BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902413331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629044411 | ||||||||
| FaxNumber: | 5629044415 | ||||||||
| Practice Location | |||||||||
| Address1: | 10800 PARAMOUNT BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902413331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629238333 | ||||||||
| FaxNumber: | 5629232433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5629044411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A4199 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0079320 | 05 | CA | MEDICAID |