Provider Demographics
NPI:1598040818
Name:SANAVIDA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SANAVIDA MEDICAL GROUP, INC.
Other - Org Name:SANAVIDA LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALJANDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-664-1279
Mailing Address - Street 1:1936 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3908
Mailing Address - Country:US
Mailing Address - Phone:562-599-2248
Mailing Address - Fax:562-599-8801
Practice Address - Street 1:1936 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3908
Practice Address - Country:US
Practice Address - Phone:562-599-2248
Practice Address - Fax:562-599-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty