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General NPI Number Information
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NPI Number | 1790119865
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Entity Type | Organization
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Legal Business Name | AIA PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 971 KUFFEL CANYON RD.
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City | SKY FOREST
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State | CA
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Zip | 92385
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Country | US
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Telephone | 909-337-5200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1502
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-1502
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Country | US
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Telephone | 310-285-1710
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EWUNIA GOSEK
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Credential |
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Telephone | 909-337-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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