Healthcare Provider Details

I. General information

NPI: 1295854701
Provider Name (Legal Business Name): CENTURY WOMEN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W PICO BLVD
LOS ANGELES CA
90006-5011
US

IV. Provider business mailing address

8679 W PICO BLVD
LOS ANGELES CA
90035-2315
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-4544
  • Fax: 213-389-4554
Mailing address:
  • Phone: 310-553-1200
  • Fax: 310-553-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHRISTOPHER CASTRO
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-553-1200