Provider Demographics
NPI:1255499208
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:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-389-4544
Mailing Address - Street 1:2080 CENTURY PARK E STE 1206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2015
Mailing Address - Country:US
Mailing Address - Phone:213-389-4544
Mailing Address - Fax:213-389-4554
Practice Address - Street 1:2080 CENTURY PARK E STE 1206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:213-389-4544
Practice Address - Fax:213-389-4554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTURY WOMEN MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0097001Medicaid
CAGR0097000Medicaid