Healthcare Provider Details

I. General information

NPI: 1376781765
Provider Name (Legal Business Name): W MAIER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29099 HOSPITAL ROAD SUITE 112
LAKE ARROWHEAD CA
92352
US

IV. Provider business mailing address

PO BOX 1141
CEDAR GLEN CA
92321-1141
US

V. Phone/Fax

Practice location:
  • Phone: 909-337-3661
  • Fax: 909-337-3570
Mailing address:
  • Phone: 909-337-3661
  • Fax: 909-337-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG82114
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG082114
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG82114
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG82114
License Number StateCA

VIII. Authorized Official

Name: MR. WALTER MARKUS MAIER
Title or Position: PRESIDENT
Credential: MD
Phone: 909-337-3661