Healthcare Provider Details

I. General information

NPI: 1235286907
Provider Name (Legal Business Name): NATIONWIDE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11776 MARIPOSA RD SUITE #103
HESPERIA CA
92345-1622
US

IV. Provider business mailing address

7246 REMMET AVENUE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 760-956-2462
  • Fax: 760-956-7542
Mailing address:
  • Phone: 818-206-0360
  • Fax: 818-206-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number14837
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE GIRGIS
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: M.D.
Phone: 661-861-9967