1497781579 NPI number — SAN CRISTOBAL MEDICAL GROUP INC.

Table of content: RUBINDEEP RUBY POWAR MD (NPI 1295045631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497781579 NPI number — SAN CRISTOBAL MEDICAL GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN CRISTOBAL MEDICAL GROUP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497781579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-413-4203
Provider Business Mailing Address Fax Number:
213-413-5615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-1890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ACOFF
Authorized Official First Name:
AMOS
Authorized Official Middle Name:
CHEERKEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
213-413-4203

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  FNP 24915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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