Provider Demographics
NPI:1922292267
Name:DREAMWEAVER CONSULTANCY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DREAMWEAVER CONSULTANCY, A MEDICAL CORPORATION
Other - Org Name:DREAMWEAVER MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:626-296-9500
Mailing Address - Street 1:420 W LAS TUNAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1268
Mailing Address - Country:US
Mailing Address - Phone:626-296-9500
Mailing Address - Fax:626-296-9505
Practice Address - Street 1:420 W LAS TUNAS DRIVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1268
Practice Address - Country:US
Practice Address - Phone:626-296-9500
Practice Address - Fax:626-296-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922292299Medicaid
CA1922292267Medicaid