Provider Demographics
NPI:1144659228
Name:MDNP PROVIDERS INC
Entity type:Organization
Organization Name:MDNP PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTROMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-408-6522
Mailing Address - Street 1:596 N LAKE AVE STE 203
Mailing Address - Street 2:203
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1222
Mailing Address - Country:US
Mailing Address - Phone:714-408-6522
Mailing Address - Fax:
Practice Address - Street 1:120 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4305
Practice Address - Country:US
Practice Address - Phone:909-576-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty