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General NPI Number Information
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NPI Number | 1063846442
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Entity Type | Organization
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Legal Business Name | FIG GARDEN MEDICAL GROUP
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 17821 17TH ST STE 250
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City | TUSTIN
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State | CA
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Zip | 92780-2173
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Country | US
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Telephone | 714-505-2093
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Fax | 714-573-0072
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Provider Business Mailing Address
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Address Line | 17821 17TH ST STE 250
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City | TUSTIN
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State | CA
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Zip | 92780-2173
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Country | US
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Telephone | 714-505-2093
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Fax | 714-573-0072
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VIVIAN WORKMAN
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Credential |
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Telephone | 714-505-2093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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