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General NPI Number Information
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NPI Number | 1154876852
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Entity Type | Organization
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Legal Business Name | GS MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 715 S AVERILL AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-3813
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Country | US
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Telephone | 424-206-8336
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Fax | 800-337-6311
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90077-1728
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Country | US
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Telephone | 310-474-9809
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Fax | 800-337-6311
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GREGORY SMITH
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Credential | M.D.
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Telephone | 424-206-8336
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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 | A50680
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License Number State | CA
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