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General NPI Number Information
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NPI Number | 1962894113
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Entity Type | Organization
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Legal Business Name | CEDAR-VALLEY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 2630 SAN GABRIEL BLVD 200
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City | ROSEMEAD
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State | CA
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Zip | 91770-5204
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Country | US
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Telephone | 626-375-6282
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 SAN GABRIEL BLVD STE 200
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City | ROSEMEAD
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State | CA
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Zip | 91770-5204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN WANG
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Credential |
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Telephone | 626-375-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A75879
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License Number State | CA
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