Basic Information
| Provider Information | |||||||||
| NPI: | 1710174818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHMC SAN GABRIEL VALLEY MEDICAL | ||||||||
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| OtherOrganizationName: | AHMC SAN GABRIEL VALLEY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 S. RAYMOND AVE. | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918019171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262895454 | ||||||||
| FaxNumber: | 6262576555 | ||||||||
| 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: | 10/02/2007 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | MARSH | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6264577488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 930000041 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.