Healthcare Provider Details

I. General information

NPI: 1821939430
Provider Name (Legal Business Name): CBG MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 LINCOLN LN
PALMDALE CA
93551-5813
US

IV. Provider business mailing address

2613 LINCOLN LN
PALMDALE CA
93551-5813
US

V. Phone/Fax

Practice location:
  • Phone: 442-453-4974
  • Fax: 747-234-2010
Mailing address:
  • Phone: 442-453-4974
  • Fax: 747-234-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICHOLAS CLAY WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 442-453-4974