Provider Demographics
NPI:1265737043
Name:PUEBLO MEDICAL CENTER INC
Entity type:Organization
Organization Name:PUEBLO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:SHARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-828-2444
Mailing Address - Street 1:8045 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2436
Mailing Address - Country:US
Mailing Address - Phone:714-828-2444
Mailing Address - Fax:714-816-0529
Practice Address - Street 1:8045 CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2436
Practice Address - Country:US
Practice Address - Phone:714-828-2444
Practice Address - Fax:714-816-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center