Organization
SAN GABRIEL PEDIATRICS MEDICAL CORPORATION
Active
Organization
SAN GABRIEL PEDIATRICS MEDICAL CORPORATION
Active
Other names
SAN GABRIEL PEDIATRICS, INC.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEZIA OGUGUA AZINGE-OBASI M.D. (PRESIDENT/CEO)
(323) 290-2832
Entity
Organization
Contact information
Practice address
3450 W 43RD ST, SUITE 107, LOS ANGELES, CA 90008-4943
(323) 290-2832
(323) 290-2836
Mailing address
3450 W 43RD ST, SUITE 107, LOS ANGELES, CA 90008-4943
(323) 290-2832
(323) 290-2836
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A53449
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A534490
—
CA
05
—
00A534491
—
CA
05
—
00A534492
—
CA
Enumeration date
07/12/2005
Last updated
03/02/2010
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