Provider Demographics
NPI:1174576607
Name:PEAK HEALTH MEDICAL GROUP INC
Entity type:Organization
Organization Name:PEAK HEALTH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSOCIATE/BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-575-3100
Mailing Address - Street 1:2143 S SEPULVEDA BLVD
Mailing Address - Street 2:300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5733
Mailing Address - Country:US
Mailing Address - Phone:310-575-3100
Mailing Address - Fax:310-575-3102
Practice Address - Street 1:2143 S SEPULVEDA BLVD
Practice Address - Street 2:300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5733
Practice Address - Country:US
Practice Address - Phone:310-575-3100
Practice Address - Fax:310-575-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15247Medicare ID - Type Unspecified