Glendale Premier Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GLENDALE PREMIER MEDICAL GROUP

Practice address

222 W Eulalia St
#201
Glendale, CA 91204-2849

Phone

(818) 240-0601

Fax

(818) 240-0687

NPI assigned

Feb 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lainis Quevedo

Title

Administrator

Phone

(818) 240-0662

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003956715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W EULALIA ST",
            "address_2": "#201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042849",
            "telephone_number": "818-240-0601",
            "fax_number": "818-240-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W EULALIA ST",
            "address_2": "#201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042849",
            "telephone_number": "818-240-0601",
            "fax_number": "818-240-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE PREMIER MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QUEVEDO",
        "authorized_official_first_name": "LAINIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-240-0662",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0098110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glendale Pathology Associates Medical Group of Glendale
• Glendale Pediatrics, a Professional Corporation
• Glendale Pharmacy Inc
• Glendale Plastic and Reconstructive Surgery Inc.
• Glendale Podiatry Group
• Glendale Primary Care Center Inc
• Glendale Professional Hearing Center,Inc
• Glendale Radiology Medical Group, Inc.
• Glendale Retina Associates Medical Group Inc.
• Glendale Sleep Diagnostic Center

• Family Medicine Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.