Healthcare Provider Details

I. General information

NPI: 1972076644
Provider Name (Legal Business Name): NEW HOPE MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WASHBURN AVE STE 6
CORONA CA
92882-3303
US

IV. Provider business mailing address

760 WASHBURN AVE STE 6
CORONA CA
92882-3303
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-6995
  • Fax: 951-268-6559
Mailing address:
  • Phone: 951-268-6995
  • Fax: 951-268-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARITZA HARRISON
Title or Position: CEO
Credential: FNP
Phone: 951-202-9083