SAN JUDAS TADEO MEDICAL GROUP INC (NPI# 1316320294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316320294 |
| Entity Type | Organization |
| Organization Name | SAN JUDAS TADEO MEDICAL GROUP INC |
| Practice Address |
1000 S La Brea Ave Ste 2 Inglewood CA 90301-3869 |
| Practice Telephone | 3103304818 |
| Practice Fax Number | 3103304822 |
| Mailing Telephone | 3103304818 |
| Mailing Fax Number | 3103304822 |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |
| Authorized Official Name | EDURADO RAUL DI SARLI (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3103304818 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
1000 S LA BREA AVE STE 2 |
| City | INGLEWOOD |
| State | CA |
| Zip Code | 90301-3869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558842 | San Judas Tadeo Medical Group, Inc. | Family Medicine | 1000 S La Brea Ave Ste 2, Inglewood, CA 90301-3869 | 2020-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548897945 | Genevieve V. Angel | Registered Nurse | 555 East Hardy Street, Director of Cm Sw, Centinela Hospital Medical Center, Inglewood, CA 90301 | 2020-03-25 |
| 1992338552 | Ralph Kevin Roque | Licensed Practical Nurse | 614 W Manchester Blvd, Inglewood, Ca 90301, 104, Inglewood, CA 90301 | 2020-02-21 |
| 1043841562 | Evelyn Jones | Social Worker | 555 E. Hardy Street, Inglewood, Ca, CA 90301 | 2020-02-03 |
| 1447896444 | Coral Dabarera Edelson | Dietitian, Registered | 110 North La Brea Ave, Inglewood, CA 90301 | 2019-11-25 |
| 1821642125 | Jennifer Robert Umoh | Student in an Organized Health Care Education/Training Program | 412 E Florence Avenue, Inglewood, CA 90301 | 2019-07-25 |
| 1821567751 | Esther Voltaire | Behavior Technician | 619 E Arbor Vitae St, Inglewood, CA 90301 | 2018-11-21 |
| 1902372832 | Pool Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 323 North Prairie Ave, Suite 200, Ingelwood, CA 90301 | 2018-10-18 |
| 1174003594 | Xelnt Healthcare Inc. | Clinic/Center | 501 E Hardy St Ste 425, Inglewood, CA 90301 | 2018-08-15 |
| 1710409321 | Rae Shelston Mcintosh | Licensed Vocational Nurse | 1007 Myrth Ave, Inglewood, CA 90301 | 2017-07-14 |
| 1477093789 | Lewis E Logan II | Counselor | 332 N. Prairie Ave., Suite 417, Inglewood, CA 90301 | 2017-03-06 |
| Find all providers in zip 90301 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558842 | San Judas Tadeo Medical Group, Inc. | Family Medicine | 1000 S La Brea Ave Ste 2, Inglewood, CA 90301-3869 | 2020-11-03 |
| 1669923454 | Balwin Clinic Inc | Family Medicine | 4508 W Imperial Hwy # B, Inglewood, CA 90304-2710 | 2016-10-18 |
| 1578876355 | Megascope Healthcare Medical Corporation. | Family Medicine | 301 North Prairie Avenue, Ste 230, Inglewood, CA 90301-4509 | 2010-07-21 |
| 1144436254 | Adaeze F. Howard | Family Medicine | 1091 S. Labrea Avenue, Inglewood, CA 90301 | 2007-05-15 |
| 1043358369 | Soheil P Hekmat | Family Medicine | 511 E Manchester Blvd, Inglewood, CA 90301-1907 | 2007-02-01 |
| 1164588141 | Parklane Medical Group | Family Medicine | 933 Centinela Ave, B, Inglewood, CA 90302-1501 | 2006-12-28 |
| 1154499655 | Rachna Kucheria | Family Medicine | 1091 S La Brea Ave, Inglewood, CA 90301 | 2006-12-01 |
| 1093809592 | Montes Medical Group Inc | Family Medicine | 832 S. Grevillea Ave., Inglewood, CA 90301-3312 | 2006-10-02 |
| 1447293378 | Marjan Saba | Family Medicine | 501 East Hardy Street Suite 205, Inglewood, CA 90301 | 2006-06-14 |
| 1285274860 | Sana Medical Center Inc | Family Medicine | 11117 S Inglewood Ave, Inglewood, CA 90304-2514 | 2020-01-10 |
| Find all providers in INGLEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.