| NPI | 1265674485 |
|---|---|
| Doing Business As | SPORTS MEDICINE & PREVENTIVE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KARLIS CONRAD ULLIS Medical Director 310-452-1990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA G20989) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: CA G20989) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2014-03-07 |