SAN JUDAS TADEO MEDICAL GROUP, INC. (NPI# 1417558842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417558842 |
| 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 | 2020-11-03 |
| Last Update Date | 2020-11-03 |
| Authorized Official Name | ROMMEL GONZALEZ (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3238214386 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | 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 |
|---|---|---|---|---|
| 1316320294 | San Judas Tadeo Medical Group Inc | Internal Medicine | 1000 S La Brea Ave Ste 2, Inglewood, CA 90301-3869 | 2015-07-09 |
| 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 | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669574802 | Horace Milano Mellon | General Practice | 915 Myrtle Ave, Inglewood, CA 90301-4007 | 2006-09-01 |
| 1699790667 | Jorge Luis Moran | General Practice | 210 S Locust St, Inglewood, CA 90301-2304 | 2006-07-12 |
| 1538439302 | Eric Jackson-scott Md Inc | General Practice | 455 N Prairie Ave, Inglewood, CA 90301-1413 | 2012-01-10 |
| 1215189071 | Clyde T. Arnold Md A Professional Corporation | General Practice | 8473 S Van Ness Ave, Suite 102, Inglewood, CA 90305-1550 | 2008-10-10 |
| 1679783559 | Adel Bashir Awad | General Practice | 1091 S La Brea Ave, Inglewood, CA 90301-3817 | 2007-05-22 |
| 1205045598 | Arnold Ellis | General Practice | 2710 W Manchester Blvd, Inglewood, CA 90305-2436 | 2007-05-22 |
| 1528270147 | Century Medical Center,a Professional Corporation | General Practice | 3451 W Century Blvd, Suite B-1, Inglewood, CA 90303-1218 | 2007-05-04 |
| 1902936099 | Centinela Medical Group | General Practice | 933 Centinela Ave, B, Inglewood, CA 90302-1501 | 2007-03-07 |
| 1952430209 | John William Mcneil Sr. | General Practice | 323 N Prairie Ave, Suite 425, Inglewood, CA 90301-4502 | 2007-03-04 |
| 1487795753 | Jorge L Moran Md Inc | General Practice | 210 S Locust St, Inglewood, CA 90301-2304 | 2007-02-09 |
| 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.