Healthcare Provider Details

I. General information

NPI: 1619908365
Provider Name (Legal Business Name): MUIR OBSTETRICS & GYNECOLOGIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA STE 200
WALNUT CREEK CA
94598-3011
US

IV. Provider business mailing address

112 LA CASA VIA STE 200
WALNUT CREEK CA
94598-3011
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-4747
  • Fax: 925-933-1638
Mailing address:
  • Phone: 925-933-4747
  • Fax: 925-933-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9796
License Number StateCA

VIII. Authorized Official

Name: LUMAN H. HUGHES III
Title or Position: PRESIDENT
Credential:
Phone: 925-933-4747