Healthcare Provider Details

I. General information

NPI: 1568532133
Provider Name (Legal Business Name): GARDENA PHYSICIANS HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 W 155TH ST
GARDENA CA
90247-4011
US

IV. Provider business mailing address

1300 W 155TH ST STE 102
GARDENA CA
90247-4049
US

V. Phone/Fax

Practice location:
  • Phone: 310-768-2235
  • Fax: 310-768-2265
Mailing address:
  • Phone: 714-488-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: RAYMOND SMITH
Title or Position: PRESIDENT
Credential:
Phone: 714-488-3188