Healthcare Provider Details

I. General information

NPI: 1649598632
Provider Name (Legal Business Name): JOSHUA TREE EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N 1ST ST
BLYTHE CA
92225-1702
US

IV. Provider business mailing address

PO BOX 11360
WESTMINSTER CA
92685-1360
US

V. Phone/Fax

Practice location:
  • Phone: 760-921-5123
  • Fax:
Mailing address:
  • Phone: 562-468-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-921-5123