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Contact Information

GRAND OB-GYN MEDICAL GROUP INC
4950 SAN BERNARDINO ST
SUTE 106
MONTCLAIR, CA91763-2328
 Phone: 909-625-0615
 Fax: 909-621-6735
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gynecologic Oncology

207VX0201X 16 Physician/Obstetrics & Gynecology
 

Maternal & Fetal Medicine

207VM0101X 16 Physician/Obstetrics & Gynecology
 

Reproductive Endocrinology

207VE0102X 16 Physician/Obstetrics & Gynecology
 

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for GRAND OB-GYN MEDICAL GROUP INC

NPI # 1043571599
LBN Legal business name GRAND OB-GYN MEDICAL GROUP INC
Authorized official THOMAS LEE - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/31/2012
Last updated 06/01/2012 - About 14 years ago
Identifiers
CA License # A37294
CA Medicaid 1477763829
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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