Healthcare Provider Details

I. General information

NPI: 1063987899
Provider Name (Legal Business Name): EVERCARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16281 MAIN ST STE B
HESPERIA CA
92345-3569
US

IV. Provider business mailing address

16281 MAIN ST STE B
HESPERIA CA
92345-3569
US

V. Phone/Fax

Practice location:
  • Phone: 442-800-5300
  • Fax:
Mailing address:
  • Phone: 442-800-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALVA MARSH
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: M.D.
Phone: 442-800-5300