1568640571 NPI number — CAMBRIDGE MEDICAL GROUP

Table of content: (NPI 1568640571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568640571 NPI number — CAMBRIDGE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIDGE MEDICAL GROUP
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:
1568640571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8504 FIRESTONE BLVD
Provider Second Line Business Mailing Address:
SUITE 399
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90241-4926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-803-6116
Provider Business Mailing Address Fax Number:
562-803-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
SUITE 204A
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-803-6116
Provider Business Practice Location Address Fax Number:
562-803-6308
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CASTANEDA
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
562-803-6116

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , 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)

  • Identifier: AO203Y . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D04603 . This is a "MEDICARE RR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 613246200 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: AO203Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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