Healthcare Provider Details

I. General information

NPI: 1265737043
Provider Name (Legal Business Name): PUEBLO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 CERRITOS AVE
STANTON CA
90680-2436
US

IV. Provider business mailing address

8045 CERRITOS AVE
STANTON CA
90680-2436
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-2444
  • Fax: 714-816-0529
Mailing address:
  • Phone: 714-828-2444
  • Fax: 714-816-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ANGELO SHARKOFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-828-2444