Provider Demographics
NPI:1063551257
Name:COMPREHENSIVE MEDICAL CENTER INC
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-882-4015
Mailing Address - Street 1:17203 MORNINGRAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10301 GARVEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2180
Practice Address - Country:US
Practice Address - Phone:626-448-0468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094880Medicaid
CAZZZ08860ZOtherBLUE CROSS GROUP #
CA00A521760Medicaid
CA00G841270Medicaid
CAZZZ08860ZOtherBLUE CROSS GROUP #
CAW17032Medicare ID - Type UnspecifiedPROVIDER GROUP #
CAWG84127DMedicare ID - Type UnspecifiedANTHONY KINGSLEY M.D.
CAG62500Medicare UPIN
CAGR0094880Medicaid