Provider Demographics
NPI:1346352259
Name:ASSOCIATED WOMENS MEDICAL CLINIC INC
Entity type:Organization
Organization Name:ASSOCIATED WOMENS MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-985-0293
Mailing Address - Street 1:811 E ELEVENTH STREET
Mailing Address - Street 2:#104
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-985-0793
Mailing Address - Fax:909-985-8326
Practice Address - Street 1:811 E ELEVENTH STREET
Practice Address - Street 2:#104
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-985-0793
Practice Address - Fax:909-985-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty