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General NPI Number Information
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NPI Number | 1154634228
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Entity Type | Organization
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Legal Business Name | NOVA MEDICAL CENTER, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 1423 W 8TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3803
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Country | US
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Telephone | 818-599-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 1197 E LOS ANGELES AVE STE C303
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City | SIMI VALLEY
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State | CA
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Zip | 93065-2868
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Country | US
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Telephone | 805-501-6685
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Fax | 866-472-9836
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RANDALL CALDRON
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Credential | MD
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Telephone | 818-599-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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