NPIMap

Organization Active NPI

Choice Medical Clinic, Inc

  • Gynecology Physician
  • Fremont, CA
National Provider Identifier
1497842561
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
GR0006545 Issued in CA
Legal business name
CHOICE MEDICAL CLINIC, INC
Practice address
1895 Mowry Ave
Suite 116
Fremont, CA 94538-1737
Phone
(510) 792-3398
Fax
(510) 792-3951
NPI assigned
Oct 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Authorized official

Name
Liza Tapia Vaughan
Title
General Manager
Phone
(408) 995-0102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VG0400X GR0006545 CA Primary

Addresses

Primary practice location

1895 Mowry Ave
Suite 116
Fremont, CA 94538-1737

Mailing address

1834 Stone Ave
Suite 2B
San Jose, CA 95125-1306
Phone (408) 995-0102

Other identifiers 1

IdentifierTypeStateIssuer
GR0006545MedicaidCA

Other names 1

  • CHOICE MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Choice Medical Clinic Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1497842561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1834 STONE AVE",
            "address_2": "SUITE 2B",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951251306",
            "telephone_number": "408-995-0102",
            "fax_number": "408-995-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 MOWRY AVE",
            "address_2": "SUITE 116",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381737",
            "telephone_number": "510-792-3398",
            "fax_number": "510-792-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOICE MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "TAPIA VAUGHAN",
        "authorized_official_first_name": "LIZA",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "408-995-0102"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CA",
            "license": "GR0006545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0006545",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHOICE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.