=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447076781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY HOPE MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 W LA PALMA AVE STE 10
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-603-7366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 W LA PALMA AVE STE 10
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-603-7366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIA VIRGINIA CABALLERO
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 714-292-9025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------