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BROOKDALE MEDICAL CENTER INC NPI 1265572903


NPI Information

NPI: 1265572903
Provider Name: BROOKDALE MEDICAL CENTER INC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D1060478

Address:
2809 TWEEDY BLVD
SOUTH GATE, CA
ZIP 90280
Phone: (323) 567-9909
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BROOKDALE MEDICAL CENTER INC is a pediatrics in South Gate, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. BROOKDALE MEDICAL CENTER INC NPI is 1265572903. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2809 TWEEDY BLVD
SOUTH GATE, CA
ZIP 90280
Phone: (323) 567-9909
Fax: (323) 567-9929

The provider's authorized official is John Barkodar .
The authorized official title is President and has the following contact phone number (323) 567-9909.

The CLIA number assigned to this NPI record is 05D1060478 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/8/2007 and was last updated on 12/23/2010.


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
1208D00000XGeneral PracticeOA44541CALIFORNIANo
2208000000XPediatricsOA44541CALIFORNIAYes

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
1GR0102030MEDICAIDCALIFORNIA

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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