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General NPI Number Information
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NPI Number | 1528430253
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Entity Type | Organization
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Legal Business Name | SAN GABRIEL RIVER MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 9500 ARTESIA BLVD
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City | BELLFLOWER
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State | CA
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Zip | 90706-6511
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Country | US
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Telephone | 562-867-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 17777 CENTER COURT DR N 600
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City | CERRITOS
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State | CA
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Zip | 90703-9320
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Country | US
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Telephone | 562-548-7474
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Fax | 562-548-7548
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADIL R MAZHAR
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Credential | MD
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Telephone | 562-548-7474
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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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