| Organization Name: | GREATER VALLEY PHYSICIANS MEDICAL GROUP INC |
| NPI Number: | 1053500991 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAKSHMAN MAKANDURA (PHYSICIAN/ OWNER) |
| Mailing Address: | 2219 S Hacienda Blvd Suite 101 Hacienda Heights |
| State: | CA US |
| Postal Code: | 917454639 |
| Phone Number: | 6269612461 |
| Fax Number: | 6263305392 |
| NPI Enumeration Date: | 10/16/2007 |
| NPI Last Update Date: | 03/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | A49715 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |