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HAWTHORNE MORNINGSIDE MEDICAL CLINIC NPI 1477692408


NPI Information

NPI: 1477692408
Provider Name: HAWTHORNE MORNINGSIDE MEDICAL CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0984221

Address:
12954 HAWTHORNE BLVD
SUITE 104
HAWTHORNE, CA
ZIP 90250
Phone: (310) 679-0269
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HAWTHORNE MORNINGSIDE MEDICAL CLINIC is a pediatrics in Hawthorne, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. HAWTHORNE MORNINGSIDE MEDICAL CLINIC NPI is 1477692408. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

12954 HAWTHORNE BLVD
SUITE 104
HAWTHORNE, CA
ZIP 90250-418
Phone: (310) 679-0269
Fax: (310) 679-1038

The provider's authorized official is Lemmon Mcmillan .
The authorized official title is Owner and has the following contact phone number (310) 901-4714.

The CLIA number assigned to this NPI record is 05D0984221 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 12/13/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineG77541CALIFORNIANo
2208000000XPediatricsA82810CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0092930MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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