Provider Demographics
NPI:1689733081
Name:SAN CRISTOBAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SAN CRISTOBAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HRABKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-4203
Mailing Address - Street 1:1930 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3605
Mailing Address - Country:US
Mailing Address - Phone:213-413-4203
Mailing Address - Fax:213-413-5615
Practice Address - Street 1:610 N. CENTRAL AVENUE
Practice Address - Street 2:SUITE109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91207
Practice Address - Country:US
Practice Address - Phone:818-507-7836
Practice Address - Fax:818-507-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39326208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty