Healthcare Provider Details

I. General information

NPI: 1093441867
Provider Name (Legal Business Name): THE HEALTH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 WARNER AVE STE 11
FOUNTAIN VALLEY CA
92708-3210
US

IV. Provider business mailing address

11317 CARMEL CREEK RD
SAN DIEGO CA
92130-2634
US

V. Phone/Fax

Practice location:
  • Phone: 562-253-5842
  • Fax:
Mailing address:
  • Phone: 562-253-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK CHAVEZ
Title or Position: OWNER
Credential: MD
Phone: 562-253-5842