NPIMap

Organization Active NPI

San Cristobal Medical Group Inc

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1689733081
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G39326 Issued in CA
Legal business name
SAN CRISTOBAL MEDICAL GROUP INC
Practice address
610 N. Central Avenue
Suite109
Los Angeles, CA 91207
Phone
(818) 507-7836
Fax
(818) 507-1285
NPI assigned
Dec 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Randall Hrabko, M.D.
Title
Vice President
Phone
(213) 413-4203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X G39326 CA Primary

Addresses

Primary practice location

610 N. Central Avenue
Suite109
Los Angeles, CA 91207

Mailing address

1930 Wilshire Blvd
Suite 410
Los Angeles, CA 90057-3605
Phone (213) 413-4203

National Provider Directory

National Provider Directory
Tax ID family
San Cristobal Medical Group Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689733081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "SUITE 410",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-413-4203",
            "fax_number": "213-413-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N. CENTRAL AVENUE",
            "address_2": "SUITE109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "91207",
            "telephone_number": "818-507-7836",
            "fax_number": "818-507-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CRISTOBAL MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HRABKO",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "213-413-4203",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G39326",
            "primary": true
        }
    ],
    "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.