Provider Demographics
NPI:1982861035
Name:GREATER SAN GABRIEL VALLEY PHYSICIANS
Entity Type:Organization
Organization Name:GREATER SAN GABRIEL VALLEY PHYSICIANS
Other - Org Name:ECMG - GSGVP
Other - Org Type:Other Name
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:OHIKHUARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-461-5030
Mailing Address - Street 1:16030 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2731
Mailing Address - Country:US
Mailing Address - Phone:818-461-5030
Mailing Address - Fax:818-461-5095
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:818-461-5030
Practice Address - Fax:818-461-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization