Provider Demographics
NPI:1245248376
Name:RECTOR WARDENS AND VESTRY OF THE CHURCH OF OUR SAVIOUR IN SAN GABRIEL
Entity type:Organization
Organization Name:RECTOR WARDENS AND VESTRY OF THE CHURCH OF OUR SAVIOUR IN SAN GABRIEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'PRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-828-5147
Mailing Address - Street 1:535 W ROSES RD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2205
Mailing Address - Country:US
Mailing Address - Phone:626-282-5147
Mailing Address - Fax:
Practice Address - Street 1:4368 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1606
Practice Address - Country:US
Practice Address - Phone:626-579-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care