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General NPI Number Information
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NPI Number | 1326208877
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Entity Type | Organization
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Legal Business Name | NOVA MEDICAL CENTER
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Dates
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Enumeration Date | 06/09/2008
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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 | PO BOX 942014
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City | SIMI VALLEY
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State | CA
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Zip | 93094-2014
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Country | US
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Telephone | 818-843-1116
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. RANDALL CALDRON
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Credential |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A64420
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License Number State | CA
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