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Provider Information for 1366484909


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SAN GABRIEL VALLEY MEDICAL CENTER

Other Names:  
Doing Business As: 
SAN GABRIEL VALLEY MEDICAL CENTER

Organization Subpart: NO

NPI: 1366484909
Last Updated: 2013-06-23
Certification Date:

Details

NameValue
NPI1366484909
Enumeration Date2006-06-11
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: HOUSHANG ABD
Title: CFO
Phone: 6265700612
Mailing Address 438 W LAS TUNAS DR
SAN GABRIEL, CA 91776-1216
United States

Phone: 626-570-6640 | Fax:626-457-7153
 
Primary Practice Address 438 W LAS TUNAS DR
SAN GABRIEL, CA 91776-1216
United States

Phone: 626-570-6640 | Fax:626-457-7153
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2094550PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336I0012X - Pharmacy - Institutional Pharmacy
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyCAPHY48932