# NOVA MEDICAL CENTER, A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOVA MEDICAL CENTER, A PROFESSIONAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154634228
- **Legal business name:** NOVA MEDICAL CENTER, A PROFESSIONAL CORPORATION
- **Authorized official:** RANDALL CALDRON MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 599-1002

## Contact information

- **Practice address:** 1423 W 8TH ST, SAN PEDRO, CA 90732-3803
- **Practice address phone:** (818) 599-1002
- **Mailing address:** 1197 E LOS ANGELES AVE STE C303, SIMI VALLEY, CA 93065-2868
- **Mailing address phone:** (805) 501-6685
- **Mailing address fax:** (866) 472-9836

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 07/19/2010
- **Last updated:** 04/03/2019