Provider Demographics
NPI:1518068592
Name:SPECTRUM WOMENS HEALTH CARE MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SPECTRUM WOMENS HEALTH CARE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DWIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-4190
Mailing Address - Street 1:637 LUCAS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1912
Mailing Address - Country:US
Mailing Address - Phone:213-977-4190
Mailing Address - Fax:213-977-4074
Practice Address - Street 1:637 LUCAS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1912
Practice Address - Country:US
Practice Address - Phone:213-977-4190
Practice Address - Fax:213-977-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62540207V00000X
CAA60760207V00000X
CAA62956207V00000X
CAG66193207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG96038Medicare UPIN
CAF11385Medicare UPIN
CAA92997Medicare UPIN
CAEQ647YMedicare UPIN
CAG94111Medicare UPIN
CAG93552Medicare UPIN