Basic Information
| Provider Information | |||||||||
| NPI: | 1356450977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOWNEY ACUTE CARE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 39159 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902390159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628093542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11500 BROOKSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629045000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUESS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5625926805 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0082650 | 05 | CA | MEDICAID |