Provider Demographics
NPI:1902006281
Name:CALIFORNIA OB/GYN
Entity Type:Organization
Organization Name:CALIFORNIA OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CPHW
Authorized Official - Phone:310-673-2647
Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-673-2647
Mailing Address - Fax:310-673-2657
Practice Address - Street 1:323 N PRAIRIE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-673-2647
Practice Address - Fax:310-673-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO70047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG23807Medicare UPIN