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SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP INC NPI 1154371623


NPI Information

NPI: 1154371623
Provider Name: SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP, INC
Classification: Obstetrics & Gynecology - 207VM0101X
Entity Type: Organization

Specialization: Maternal & Fetal Medicine

CLIA Number: 05D1051430

Address:
1135 S SUNSET AVE
STE 402
WEST COVINA, CA
ZIP 91790
Phone: (626) 337-4425
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SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP, INC is a maternal and fetal medicine obstetrics gynecology in West Covina, CA. The provider is an obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies. SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP, INC NPI is 1154371623. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1135 S SUNSET AVE
STE 402
WEST COVINA, CA
ZIP 91790-938
Phone: (626) 337-4425
Fax: (626) 337-4606

The provider's authorized official is Carmen O Avila .
The authorized official title is Office Manager and has the following contact phone number (626) 337-4425.

The CLIA number assigned to this NPI record is 05D1051430 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/12/2006 and was last updated on 6/20/2018.


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
1207VM0101XObstetrics & GynecologyMaternal & Fetal MedicineCALIFORNIAYes

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
100A507640MEDICAIDCALIFORNIA
2=========OTHERCALIFORNIATAX ID
300G794030MEDICAIDCALIFORNIA
4G71304OTHERCALIFORNIABRENDA ROSS, M.D.

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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