NPIMap

Organization Active NPI

San Gabriel Physicians Specialty Medical Group

  • Legal Medicine
  • Los Angeles, CA
National Provider Identifier
1306050463
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
A33207 Issued in CA
Legal business name
SAN GABRIEL PHYSICIANS SPECIALTY MEDICAL GROUP
Practice address
2411 Daly Street
Los Angeles, CA 90031
Phone
(323) 223-9931
Fax
(323) 223-1229
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Maria Eugenia Khalatian, M.D.
Title
Pediatrician
Phone
(323) 223-9931

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 173000000X A33207 CA Primary
Legal MedicineGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 173000000X A31083 CA

Addresses

Primary practice location

2411 Daly Street
Los Angeles, CA 90031

Mailing address

2411 Daly Street
Los Angeles, CA 90031
Phone (323) 223-9931

National Provider Directory

National Provider Directory

Locations

2411 Daly St
Los Angeles, CA 90031
Phone (323) 223-9931

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306050463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 DALY STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90031",
            "telephone_number": "323-223-9931",
            "fax_number": "323-223-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 DALY STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90031",
            "telephone_number": "323-223-9931",
            "fax_number": "323-223-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL PHYSICIANS SPECIALTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHALATIAN",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "EUGENIA",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "323-223-9931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "A33207",
            "primary": true
        },
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "A31083",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • 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.