CISCO MEDICAL GROUP INC NPI 1053408989

NPI Information

NPI: 1053408989
Provider Name: CISCO MEDICAL GROUP, INC

Doing Business As: CISCO MEDICAL GROUP - RESEDA

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
18518 SHERMAN WAY
RESEDA, CA
ZIP 91335
Phone: (818) 757-0954
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CISCO MEDICAL GROUP, INC is a primary care clinic center in Reseda, CA. CISCO MEDICAL GROUP, INC NPI is 1053408989. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Cisco Medical Group - Reseda.

The provider's business location address is:

18518 SHERMAN WAY
RESEDA, CA
ZIP 91335-212
Phone: (818) 757-0954
Fax: (818) 757-0963

The provider's authorized official is Jose Francisco Martinez Cardenas .
The authorized official title is President/medical Director and has the following contact phone number (818) 757-0954.

The enumeration date for this NPI number is 10/10/2006 and was last updated on 3/25/2023.

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 Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207R00000X	Internal Medicine		No
2	208000000X	Pediatrics		No
3	208D00000X	General Practice		No
4	261QP2300X	Clinic/Center	Primary Care	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0103250	MEDICAID	CALIFORNIA
2	05D1055441	OTHER	CALIFORNIA	CLIA

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: 5/5/2024

NPI Synchronization or Removal

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