Great Spirit Medical Group,inc
NPI #1407869928 in Northridge, California
Provider Information
- NPI Number
- 1407869928
- Entity Type
- Organization
- Organization Name
- Great Spirit Medical Group,inc
- Primary Specialty
- Family Medicine
- Enumeration Date
- Aug 14, 2006
- Last Updated
- Nov 12, 2007
Practice Location
- Address
- 9900 BALBOA BLVD
- Address 2
- SUITE A
- City
- Northridge
- State
- California
- ZIP Code
- 91325-5403
- Phone
- (818) 701-0017
Authorized Official
- Name
- DR. CONRADO J.R MIRANDA IV, MD
- Title
- MEDICAL DIRECTOR
- Phone
- (818) 701-0017
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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