Basic Information
| Provider Information | |||||||||
| NPI: | 1487939724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHMC SAN GABRIEL VALLEY MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 S RAYMOND AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918017101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264577938 | ||||||||
| FaxNumber: | 6264577908 | ||||||||
| Practice Location | |||||||||
| Address1: | 438 W LAS TUNAS DR | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917761216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262895454 | ||||||||
| FaxNumber: | 6262576555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARSH | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6264577938 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 930000041 | CA | Y | Hospital Units | Psychiatric Unit |
No ID Information.