Healthcare Provider Details

I. General information

NPI: 1699050914
Provider Name (Legal Business Name): SANAVIDA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 WHITTIER BLVD
PICO RIVERA CA
90660-2450
US

IV. Provider business mailing address

9217 WHITTIER BLVD
PICO RIVERA CA
90660-2450
US

V. Phone/Fax

Practice location:
  • Phone: 562-699-5888
  • Fax: 562-699-2955
Mailing address:
  • Phone: 562-699-5888
  • Fax: 562-699-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO L GONZALEZ
Title or Position: OWNER
Credential: DO
Phone: 626-664-1279