Healthcare Provider Details

I. General information

NPI: 1538462320
Provider Name (Legal Business Name): WINTERHAVEN EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

PO BOX 1090
LONG BEACH CA
90801-1090
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4141
  • Fax:
Mailing address:
  • Phone: 562-468-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: PRESIDENT
Credential: MD
Phone: 925-225-5837