Basic Information
| Provider Information | |||||||||
| NPI: | 1801013768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALMDALE WOMEN AND CHILDREN'S CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3005 E PALMDALE BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935501831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615750009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3005 E PALMDALE BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935501831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615750009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GITTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6615750009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | A33447 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VX0000X | A33447 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 208000000X | A30390 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | G20658 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | G20658 | 01 | CA | MEDICAL LICENSE | OTHER |