Healthcare Provider Details

I. General information

NPI: 1861599144
Provider Name (Legal Business Name): MMR MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HANNA AVE STE 1
CORCORAN CA
93212-2314
US

IV. Provider business mailing address

PO BOX 71
HANFORD CA
93232-0071
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-3300
  • Fax: 559-992-8162
Mailing address:
  • Phone: 559-992-3300
  • Fax: 559-992-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN R MEDINA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-992-3300