| Rephana Medical Group | |
|
1304 15th St Ste 402 Santa Monica CA 90404-1813 | |
| (310) 451-0111 | |
| Not Available |
| Full Name | Rephana Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1304 15th St Ste 402, Santa Monica, California |
| Authorized Official Name and Position | Neal Shanblatt (PRESIDENT) |
| Authorized Official Contact | 3104510111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rephana Medical Group 5850 W 3rd St # 132 Los Angeles CA 90036-2860 Ph: (310) 451-0111 | Rephana Medical Group 1304 15th St Ste 402 Santa Monica CA 90404-1813 Ph: (310) 451-0111 |
| NPI Number | 1659414258 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9335264019 |
|---|---|
| Medicare Enrollment ID | O20100917001000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659414258 | NPI | - | NPPES |
| 00A646470 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A64647 (California) | Primary |
| Provider Name | Neal Shanblatt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922092410 PECOS PAC ID: 0244355923 Enrollment ID: I20100917001026 |
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