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General NPI Number Information
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NPI Number | 1609832252
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Entity Type | Organization
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Legal Business Name | HILLSIDE OBSTETRICS & GYNECOLGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 680 GUZZI LN SUITE 106
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-536-3750
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Fax | 209-532-9811
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Provider Business Mailing Address
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Address Line | 680 GUZZI LN SUITE 106
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-536-3750
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Fax | 209-532-9811
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONOVAN D TEEL
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Credential | M.D.
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Telephone | 209-536-3750
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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 | G30879
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License Number State | CA
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