Healthcare Provider Details

I. General information

NPI: 1275720377
Provider Name (Legal Business Name): AHMC SAN GABRIEL VALLEY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 W LAS TUNAS DR
SAN GABRIEL CA
91776-1216
US

IV. Provider business mailing address

55 S RAYMOND AVE STE 105
ALHAMBRA CA
91801
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-5454
  • Fax: 626-257-6555
Mailing address:
  • Phone: 626-457-7938
  • Fax: 626-457-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number930000041
License Number StateCA

VIII. Authorized Official

Name: LINDA MARSH
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 626-457-7938