Provider Demographics
NPI:1235790718
Name:CENTURY WOMEN MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CENTURY WOMEN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:310-553-1200
Mailing Address - Street 1:8679 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2315
Mailing Address - Country:US
Mailing Address - Phone:310-553-1200
Mailing Address - Fax:310-553-1216
Practice Address - Street 1:13309 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3006
Practice Address - Country:US
Practice Address - Phone:310-553-1200
Practice Address - Fax:310-553-1216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTURY WOMEN MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821161860Medicaid
CA1285753723Medicaid
CA1275619736Medicaid
CA1093834533Medicaid