Healthcare Provider Details

I. General information

NPI: 1992120794
Provider Name (Legal Business Name): HIZON MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 07/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE SUITE 101
TEMECULA CA
92590-2661
US

IV. Provider business mailing address

25495 MEDICAL CENTER DR SUITE 305
MURRIETA CA
92562-4902
US

V. Phone/Fax

Practice location:
  • Phone: 951-790-0107
  • Fax: 951-667-1933
Mailing address:
  • Phone: 951-790-0107
  • Fax: 951-667-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG55359
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG55359
License Number StateCA

VIII. Authorized Official

Name: GERARDO WILLIAM HIZON
Title or Position: PRESIDENT / PHYSICIAN
Credential: M.D.
Phone: 951-790-0107