Provider Demographics
NPI:1023450087
Name:MDNP PROVIDERS
Entity type:Organization
Organization Name:MDNP PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTROMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-408-6522
Mailing Address - Street 1:596 N LAKE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:596 N LAKE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1455
Practice Address - Country:US
Practice Address - Phone:626-272-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH ALLIED SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty