Organization
SOUTH CERRITOS MEDICAL GROUP, INC.
Active
Organization
SOUTH CERRITOS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONCHITA YATAR GOINGS M.D. (PHYSICIAN)
(562) 809-1434
Entity
Organization
Contact information
Practice address
20927 NORWALK BLVD, LAKEWOOD, CA 90715-1545
(562) 809-1434
(562) 809-1526
Mailing address
13381 SILVER BERRY CIR, CERRITOS, CA 90703-1374
(562) 809-1434
(562) 809-1526
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A41071
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A41071
STATE LICENSE
CA
01
—
W13073
GROUP NUMBER
CA
Enumeration date
04/16/2007
Last updated
08/22/2020
Update your record
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