Provider Demographics
NPI:1275961542
Name:MEDICAL PLAZA OF SAN PEDRO
Entity Type:Organization
Organization Name:MEDICAL PLAZA OF SAN PEDRO
Other - Org Name:SAN PEDRO FAMILY & URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TASHINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-831-0003
Mailing Address - Street 1:529 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3115
Mailing Address - Country:US
Mailing Address - Phone:310-831-0003
Mailing Address - Fax:
Practice Address - Street 1:529 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3115
Practice Address - Country:US
Practice Address - Phone:310-831-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site