Healthcare Provider Details

I. General information

NPI: 1679273361
Provider Name (Legal Business Name): CALIFORNIA CHILDREN SERVICES - MTU PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 TELSTAR AVE
EL MONTE CA
91731-2816
US

IV. Provider business mailing address

9320 TELSTAR AVE
EL MONTE CA
91731-2816
US

V. Phone/Fax

Practice location:
  • Phone: 626-569-6011
  • Fax:
Mailing address:
  • Phone: 626-569-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NAMAN SHAH
Title or Position: DIRECTOR DMDA
Credential: MD
Phone: 213-288-8582