Organization
CEDARS NORTHWEST MEDICAL GROUP, INC.
Active
Other names
CEDAR NORTHWEST DIAGNOSTIC MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON BOUTROS M.D. (PRESIDENT)
(626) 791-0953
Entity
Organization
Contact information
Practice address
1403 N FAIR OAKS AVE, STE 2, PASADENA, CA 91103-1858
(626) 791-0953
Mailing address
1403 N FAIR OAKS AVE, STE 2, PASADENA, CA 91103-1858
(626) 791-0953
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2775917
CORPORATION NUMBER
CA
Enumeration date
08/05/2006
Last updated
08/22/2020
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