Provider Demographics
NPI:1205874237
Name:KINTAUDI & ASSOCIATES MEDICAL GROUP, INC
Entity type:Organization
Organization Name:KINTAUDI & ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRUDENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTAUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-256-1633
Mailing Address - Street 1:1125 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3911
Mailing Address - Country:US
Mailing Address - Phone:562-256-1633
Mailing Address - Fax:562-256-1635
Practice Address - Street 1:1125 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3911
Practice Address - Country:US
Practice Address - Phone:562-256-1633
Practice Address - Fax:562-256-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG31192GOtherPPIN
CAG31192OtherMEDICAL LICENSE
CAWPA11462AOtherPPIN
CAG31192OtherMEDICAL LICENSE
CAWPA11462AOtherPPIN