Provider Demographics
NPI:1528430253
Name:SAN GABRIEL RIVER MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:SAN GABRIEL RIVER MEDICAL GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-548-7474
Mailing Address - Street 1:17777 CENTER COURT DR N
Mailing Address - Street 2:600
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9320
Mailing Address - Country:US
Mailing Address - Phone:562-548-7474
Mailing Address - Fax:562-548-7548
Practice Address - Street 1:9500 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6511
Practice Address - Country:US
Practice Address - Phone:562-867-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty