Provider Demographics
NPI:1598040784
Name:MATERNAL FETAL MEDICINE MEDICAL GROUP OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:MATERNAL FETAL MEDICINE MEDICAL GROUP OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARDESHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-282-9250
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-0219
Mailing Address - Country:US
Mailing Address - Phone:626-282-9250
Mailing Address - Fax:626-282-9953
Practice Address - Street 1:207 S. SANTA ANITA STREET
Practice Address - Street 2:SUITE 338
Practice Address - City:SANGABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1160
Practice Address - Country:US
Practice Address - Phone:626-282-9250
Practice Address - Fax:626-282-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50980170100000X, 174400000X
A50980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6727433Medicaid
CA6727433Medicaid
CAF91282Medicare UPIN