Organization
CHILDRENS CARDIAC MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L STEPHEN GORDON M.D. (OWNER)
(626) 445-5552
Entity
Organization
Contact information
Practice address
301 W HUNTINGTON DR, #415, ARCADIA, CA 91007-3462
(626) 445-5552
(626) 445-4411
Mailing address
301 W HUNTINGTON DR, #415, ARCADIA, CA 91007-3462
(626) 445-5552
(626) 445-4411
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
G12458
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G124580
—
CA
Enumeration date
11/22/2005
Last updated
07/23/2007
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