Healthcare Provider Details

I. General information

NPI: 1770864621
Provider Name (Legal Business Name): TELEHEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E CHAPMAN AVE
ORANGE CA
92866-1643
US

IV. Provider business mailing address

615 E CHAPMAN AVE
ORANGE CA
92866-1643
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4012
  • Fax: 714-639-4018
Mailing address:
  • Phone: 714-639-4012
  • Fax: 714-639-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A4401
License Number StateCA

VIII. Authorized Official

Name: DR. BRYN JARALD HENDERSON
Title or Position: PARTNER
Credential: DO
Phone: 714-981-8058