Boston Medical Group California LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

G9455 Issued in CA

Legal business name

BOSTON MEDICAL GROUP CALIFORNIA LLC

Practice address

207 S Santa Anita Ave
P25A
San Gabriel, CA 91776

Phone

(615) 562-4578

Fax

(423) 949-3992

NPI assigned

Dec 19, 2014

Last updated

Dec 19, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joan Simpson

Title

Director of CQRM

Phone

(615) 562-4578

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1418947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1851799001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23275 S POINTE DRIVE",
            "address_2": "SUITE 100",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "92653",
            "telephone_number": "615-562-4578",
            "fax_number": "423-949-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 S SANTA ANITA AVE",
            "address_2": "P25A",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "91776",
            "telephone_number": "615-562-4578",
            "fax_number": "423-949-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MEDICAL GROUP CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-19",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "DIRECTOR OF CQRM",
        "authorized_official_telephone_number": "615-562-4578"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "G9455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; 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.