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General NPI Number Information
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NPI Number | 1457167306
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Entity Type | Organization
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Legal Business Name | PHOENIX HORIZON MEDICAL GROUP
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1211 PLEASANT GROVE BLVD STE 120
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City | ROSEVILLE
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State | CA
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Zip | 95678-6988
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Country | US
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Telephone | 916-791-8346
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Fax | 916-791-8833
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Provider Business Mailing Address
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Address Line | 1211 PLEASANT GROVE BLVD STE 120
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City | ROSEVILLE
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State | CA
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Zip | 95678-6988
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Country | US
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Telephone | 916-791-8346
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Fax | 916-791-8833
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Authorized Official
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Title or Position | OWNER/OPERATOR/PRESIDENT
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Name | DR. WYNTER NIGEL PHOENIX
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Credential | MD
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Telephone | 916-791-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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