Healthcare Provider Details

I. General information

NPI: 1952335994
Provider Name (Legal Business Name): HOSPITAL PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

PO BOX 11515
GLENDALE CA
91226-7515
US

V. Phone/Fax

Practice location:
  • Phone: 818-638-8900
  • Fax: 818-247-3434
Mailing address:
  • Phone: 818-638-8900
  • Fax: 818-247-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH F. BORNHEIMER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-638-8900