NPIMap

Organization Active NPI

San Gabriel Pediatrics Medical Corporation

  • Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1962400028
Registry record updated Mar 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
A53449 Issued in CA
Legal business name
SAN GABRIEL PEDIATRICS MEDICAL CORPORATION
Practice address
3450 W 43Rd St
Suite 107
Los Angeles, CA 90008-4943
Phone
(323) 290-2832
Fax
(323) 290-2836
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2010

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

Authorized official

Name
Dr. Mezia Ogugua Azinge-Obasi, M.D.
Title
President/Ceo
Phone
(323) 290-2832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X A53449 CA Primary

Addresses

Primary practice location

3450 W 43Rd St
Suite 107
Los Angeles, CA 90008-4943

Mailing address

3450 W 43Rd St
Suite 107
Los Angeles, CA 90008-4943
Phone (323) 290-2832

Other identifiers 3

IdentifierTypeStateIssuer
00A534492MedicaidCA
00A534491MedicaidCA
00A534490MedicaidCA

Other names 1

  • SAN GABRIEL PEDIATRICS, INC. Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1962400028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 W 43RD ST",
            "address_2": "SUITE 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900084943",
            "telephone_number": "323-290-2832",
            "fax_number": "323-290-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 W 43RD ST",
            "address_2": "SUITE 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900084943",
            "telephone_number": "323-290-2832",
            "fax_number": "323-290-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL PEDIATRICS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "AZINGE-OBASI",
        "authorized_official_first_name": "MEZIA",
        "authorized_official_middle_name": "OGUGUA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "323-290-2832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A53449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A534492",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A534491",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A534490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN GABRIEL PEDIATRICS, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Mar 2, 2010; 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.