NPIMap

Organization Active NPI

San Gabriel Valley Perinatal Medical Group, Inc

  • Maternal & Fetal Medicine Physician
  • West Covina, CA
National Provider Identifier
1154371623
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
Legal business name
SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP, INC
Practice address
1135 S Sunset Ave
Ste 402
West Covina, CA 91790-3938
Phone
(626) 337-4425
Fax
(626) 337-4606
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Ms. Carmen O Avila
Title
Office Manager
Phone
(626) 337-4425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VM0101X CA Primary

Addresses

Primary practice location

1135 S Sunset Ave
Ste 402
West Covina, CA 91790-3938

Mailing address

1135 S Sunset Ave
Ste 402
West Covina, CA 91790-3938
Phone (626) 337-4425

Other identifiers 3

IdentifierTypeStateIssuer
G71304OtherCABRENDA ROSS, M.D.
00G794030MedicaidCA
00A507640MedicaidCA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0943682San Gabriel Valley Perinatal Medical Group Inc1135 S Sunset Avenue Suite 208, West Covina, CA 91790Certificate of waiverMar 30, 2028

National Provider Directory

National Provider Directory

Locations

120 W Hellman Ave
Ste 301
Monterey Park, CA 91754
Phone (626) 571-1000

1135 S Sunset Ave
Ste 402
West Covina, CA 91790
Phone (626) 337-4425

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1154371623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 S SUNSET AVE",
            "address_2": "STE 402",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903938",
            "telephone_number": "626-337-4425",
            "fax_number": "626-337-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 S SUNSET AVE",
            "address_2": "STE 402",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903938",
            "telephone_number": "626-337-4425",
            "fax_number": "626-337-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL VALLEY PERINATAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "626-337-4425",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRENDA ROSS, M.D.",
            "identifier": "G71304",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G794030",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A507640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.