Healthcare Provider Details

I. General information

NPI: 1891589503
Provider Name (Legal Business Name): MEDXCEL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S GLENWOOD PL STE 113
BURBANK CA
91506-2819
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 110
NEWHALL CA
91321-5730
US

V. Phone/Fax

Practice location:
  • Phone: 747-209-0940
  • Fax: 818-356-4380
Mailing address:
  • Phone: 818-636-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE DUNN
Title or Position: CEO
Credential: NP
Phone: 747-209-0904