Great Spirit Medical Group,Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A48817 Issued in CA

Legal business name

GREAT SPIRIT MEDICAL GROUP,INC

Practice address

9900 Balboa Blvd
Suite a
Northridge, CA 91325-5403

Phone

(818) 701-0017

Fax

(818) 701-0073

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Conrado J.R Miranda IV, MD

Title

Medical Director

Phone

(818) 701-0017

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1407869928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 BALBOA BLVD",
            "address_2": "SUITE A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255403",
            "telephone_number": "818-701-0017",
            "fax_number": "818-701-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BALBOA BLVD",
            "address_2": "SUITE A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255403",
            "telephone_number": "818-701-0017",
            "fax_number": "818-701-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SPIRIT MEDICAL GROUP,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "CONRADO",
        "authorized_official_middle_name": "J.R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-701-0017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A48817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Cristina Granados
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• Gratify Care Hospice
• Calvin W Gray, D.D.S.
• Anna Grebin
• Steven J Grech
• Andrea L. Green, MD
• Deidre Green
• Julia Amarilis Green

• Family Medicine Physician in Northridge, CA
• Providers in Northridge, 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 Nov 12, 2007; 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.