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General NPI Number Information
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NPI Number | 1043703150
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Entity Type | Organization
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Legal Business Name | CITRUS VALLEY PHYSICIAN PARTNERS
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 1135 S SUNSET AVE STE 401
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City | WEST COVINA
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State | CA
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Zip | 91790-3921
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Country | US
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Telephone | 626-962-8122
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Fax | 626-962-8408
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Provider Business Mailing Address
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Address Line | 1325 N GRAND AVE STE 300
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City | COVINA
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State | CA
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Zip | 91724-4046
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Country | US
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Telephone | 626-732-3159
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Fax | 626-732-3194
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Authorized Official
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Title or Position | ASSIST. DIRECTOR OF AMBULATORY BUS.
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Name | CHRISTINE HADDAD
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Credential |
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Telephone | 626-732-3159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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