Cedars Northwest Medical Group, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CEDARS NORTHWEST MEDICAL GROUP, INC.

Practice address

1403 N Fair Oaks Ave
Ste 2
Pasadena, CA 91103-1858

Phone

(626) 791-0953

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jason Boutros, M.D.

Title

President

Phone

(626) 791-0953

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CEDAR NORTHWEST DIAGNOSTIC MEDICAL GROUP Doing business as

Locations

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225047723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 N FAIR OAKS AVE",
            "address_2": "STE 2",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031858",
            "telephone_number": "626-791-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 N FAIR OAKS AVE",
            "address_2": "STE 2",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031858",
            "telephone_number": "626-791-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARS NORTHWEST MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOUTROS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-791-0953",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION NUMBER",
            "identifier": "C2775917",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CEDAR NORTHWEST DIAGNOSTIC MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Isabel Ceballos
• Rachel Lynn Ceballos
• Vanessa Ceballos
• Kevin J Cebula, D.D.S.
• Alison L Cedano
• Camila Guadalupe Ceja Valladolid
• Juanita Isabel Ceja
• Jeanette Cejudo
• Rosalinda Celaya, HOUSING SPECIALIST
• Claire Olivia Celestin

• Specialist in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Specialist 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.