Provider Demographics
NPI:1669680443
Name:AURORA MEDICAL CENTER OF SAN FERNANDO, INC
Entity Type:Organization
Organization Name:AURORA MEDICAL CENTER OF SAN FERNANDO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-244-7404
Mailing Address - Street 1:405 N MACLAY AVE
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2445
Mailing Address - Country:US
Mailing Address - Phone:818-361-3318
Mailing Address - Fax:818-361-7309
Practice Address - Street 1:405 N MACLAY AVE
Practice Address - Street 2:SUITE # 104
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2445
Practice Address - Country:US
Practice Address - Phone:818-361-3318
Practice Address - Fax:818-361-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0104540Medicaid