Healthcare Provider Details

I. General information

NPI: 1982996724
Provider Name (Legal Business Name): MIRAMAR HEALTH PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 GARNETT AVE.
SAN DIEGO CA
92109
US

IV. Provider business mailing address

400 ALTON ROAD TH-4A
MIAMI BEACH FL
33139
US

V. Phone/Fax

Practice location:
  • Phone: 619-762-4632
  • Fax: 866-675-5593
Mailing address:
  • Phone: 949-370-0771
  • Fax: 866-675-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DERIK BRIAN
Title or Position: OWNER
Credential:
Phone: 949-370-0771