Healthcare Provider Details

I. General information

NPI: 1972774438
Provider Name (Legal Business Name): HEALTH PLUS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 NEWPORT RD SUITE 110
MENIFEE CA
92584-9222
US

IV. Provider business mailing address

26900 NEWPORT RD SUITE 110
MENIFEE CA
92584-9222
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-8060
  • Fax: 951-672-7490
Mailing address:
  • Phone: 951-672-8060
  • Fax: 951-672-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA71363
License Number StateCA

VIII. Authorized Official

Name: GARDNER D. TARLOW
Title or Position: PRESIDENT
Credential: MD
Phone: 951-672-8060