Healthcare Provider Details

I. General information

NPI: 1497444905
Provider Name (Legal Business Name): CM PROVIDERS MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 08/31/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3640
US

IV. Provider business mailing address

625 THE CITY DR S STE 310
ORANGE CA
92868-4949
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-9943
  • Fax: 657-226-2907
Mailing address:
  • Phone: 866-433-9943
  • Fax: 657-226-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TARUN MARWAHA
Title or Position: PRESIDENT
Credential: MD
Phone: 866-433-9943