Provider Demographics
NPI:1023187077
Name:SAN GABRIEL ORTHOPAEDIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SAN GABRIEL ORTHOPAEDIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:C. RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-357-6363
Mailing Address - Street 1:51 N. 5TH AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-357-6363
Mailing Address - Fax:
Practice Address - Street 1:51 N. 5TH AVE
Practice Address - Street 2:STE 301
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-357-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10358Medicare PIN
CACP2198Medicare PIN
CA0766060001Medicare NSC