Provider Demographics
NPI:1730339730
Name:CENTRO GINECOLOGICO BALDWIN PARK
Entity type:Organization
Organization Name:CENTRO GINECOLOGICO BALDWIN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CERVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-480-0160
Mailing Address - Street 1:14311 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3242
Mailing Address - Country:US
Mailing Address - Phone:626-480-0160
Mailing Address - Fax:626-480-0167
Practice Address - Street 1:14311 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3242
Practice Address - Country:US
Practice Address - Phone:626-480-0160
Practice Address - Fax:626-480-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty