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General NPI Number Information
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NPI Number | 1457546723
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Entity Type | Organization
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Legal Business Name | LATHAM ORTHOPEDICS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 371 N SAN JACINTO ST STE A
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City | HEMET
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State | CA
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Zip | 92543-3105
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Country | US
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Telephone | 951-658-1942
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Fax | 951-658-9776
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Provider Business Mailing Address
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Address Line | PO BOX 5594
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City | HEMET
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State | CA
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Zip | 92544-0594
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Country | US
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Telephone | 951-658-1942
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Fax | 951-658-9776
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Authorized Official
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Title or Position | MD/CEO
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Name | DR. JEROME ROBERT MUELLER
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Credential | MD
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Telephone | 951-658-1942
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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 | G30868
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License Number State | CA
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