Provider Demographics
NPI:1336266402
Name:SAN PEDRO OB-GYN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAN PEDRO OB-GYN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TISCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-831-1266
Mailing Address - Street 1:1300 W 6TH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3531
Mailing Address - Country:US
Mailing Address - Phone:310-831-1266
Mailing Address - Fax:424-342-7888
Practice Address - Street 1:1300 W 6TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-831-1266
Practice Address - Fax:424-342-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13428Medicare PIN
CAW13428Medicare ID - Type Unspecified