Healthcare Provider Details

I. General information

NPI: 1639401987
Provider Name (Legal Business Name): CHOICE PHYSICIANS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

IV. Provider business mailing address

19111 TOWN CENTER DRIVE
APPLE VALLEY CA
92308
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-7777
  • Fax: 760-242-0487
Mailing address:
  • Phone: 760-242-7777
  • Fax: 760-242-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. MANMOHAN NAYYAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-242-7777