Healthcare Provider Details

I. General information

NPI: 1043373053
Provider Name (Legal Business Name): GARDENS REGIONAL HOSPITAL AND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax: 562-924-5871
Mailing address:
  • Phone: 562-860-0401
  • Fax: 562-924-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number930000030
License Number StateCA

VIII. Authorized Official

Name: ANTHONY CARRASCO
Title or Position: DIRECTOR, INFORMATION SYSTEMS
Credential:
Phone: 562-303-1044