Provider Demographics
NPI:1962195008
Name:CONCERTOCARE PACE OF CALIFORNIA, PC
Entity type:Organization
Organization Name:CONCERTOCARE PACE OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-292-6258
Mailing Address - Street 1:PO BOX 801280
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1280
Mailing Address - Country:US
Mailing Address - Phone:949-292-6258
Mailing Address - Fax:
Practice Address - Street 1:3680 DEGNAN BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018
Practice Address - Country:US
Practice Address - Phone:949-292-6258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty