Provider Demographics
NPI:1659870228
Name:CITRUS VALLEY PHYSICIAN PARTNERS
Entity Type:Organization
Organization Name:CITRUS VALLEY PHYSICIAN PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSIST. DIRECTOR OF AMBULATORY BUS.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-732-3159
Mailing Address - Street 1:1325 N GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-4046
Mailing Address - Country:US
Mailing Address - Phone:626-732-3159
Mailing Address - Fax:626-732-3194
Practice Address - Street 1:412 W CARROLL AVE STE 107
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4708
Practice Address - Country:US
Practice Address - Phone:626-914-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty