Healthcare Provider Details

I. General information

NPI: 1457408858
Provider Name (Legal Business Name): NATIONWIDE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6597
  • Fax: 805-922-5978
Mailing address:
  • Phone: 818-206-0360
  • Fax: 818-206-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE GIRGIS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 661-861-9967