Healthcare Provider Details

I. General information

NPI: 1164467973
Provider Name (Legal Business Name): MAGUIRE & WELSH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7624 PAINTER AVE #100
WHITTIER CA
90602-2357
US

IV. Provider business mailing address

7624 PAINTER AVE #100
WHITTIER CA
90602-2357
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-9333
  • Fax: 562-945-8533
Mailing address:
  • Phone: 562-945-9333
  • Fax: 562-945-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7501
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A4248
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A4272
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL J MAGUIRE
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 562-945-9333