Provider Demographics
NPI:1568640571
Name:CAMBRIDGE MEDICAL GROUP
Entity type:Organization
Organization Name:CAMBRIDGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-803-6116
Mailing Address - Street 1:8504 FIRESTONE BLVD
Mailing Address - Street 2:SUITE 399
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4926
Mailing Address - Country:US
Mailing Address - Phone:562-803-6116
Mailing Address - Fax:562-803-6308
Practice Address - Street 1:10800 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 204A
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3331
Practice Address - Country:US
Practice Address - Phone:562-803-6116
Practice Address - Fax:562-803-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO203YOtherMEDICARE PTAN
CAD04603OtherMEDICARE RR
613246200OtherUS DEPARTMENT OF LABOR
CAAO203ZOtherMEDICARE PTAN