Provider Demographics
NPI:1295854701
Name:CENTURY WOMEN MEDICAL GROUP, INC
Entity type:Organization
Organization Name:CENTURY WOMEN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-553-1200
Mailing Address - Street 1:8679 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2315
Mailing Address - Country:US
Mailing Address - Phone:310-553-1200
Mailing Address - Fax:310-553-1216
Practice Address - Street 1:2030 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5011
Practice Address - Country:US
Practice Address - Phone:213-389-4544
Practice Address - Fax:213-389-4554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTURY WOMEN MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285753723Medicaid
CAGR0097000Medicaid
CA1821161860OtherNPI
CA1275619736OtherNPI
CAGR0097001OtherGROUP #