Basic Information
| Provider Information | |||||||||
| NPI: | 1730400342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEEN OF THE VALLEY MEDICAL ASSOCIATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA 21190 | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911851190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072511850 | ||||||||
| FaxNumber: | 7072511860 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 TRANCAS ST | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945582900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144494800 | ||||||||
| FaxNumber: | 7144494956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2010 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCARBOROUGH | ||||||||
| AuthorizedOfficialFirstName: | R | ||||||||
| AuthorizedOfficialMiddleName: | BRUCE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL GROUP PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7072511850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.