Organization
BEVERLY PEDIATRIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HECTOR NAHUN DE LA ROCHA M.D. (PRESIDENT/OWNER)
(323) 728-3270
Entity
Organization
Contact information
Practice address
1417 W BEVERLY BLVD, SUITE 102, MONTEBELLO, CA 90640-4123
(323) 728-3270
(323) 728-2141
Mailing address
1417 W BEVERLY BLVD, SUITE 102, MONTEBELLO, CA 90640-4146
(323) 728-3270
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G42466
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0013040
—
CA
Enumeration date
09/20/2006
Last updated
08/14/2013
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