Provider Demographics
NPI:1528359197
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 ADMIN
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:310-553-1200
Mailing Address - Street 1:7301 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5823
Mailing Address - Country:US
Mailing Address - Phone:323-581-5120
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2008
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:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82337207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty