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General NPI Number Information
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NPI Number | 1972076644
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Entity Type | Organization
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Legal Business Name | NEW HOPE MEDICAL GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/06/2019
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 760 WASHBURN AVE STE 6
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-268-6995
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Fax | 951-268-6559
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Provider Business Mailing Address
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Address Line | 760 WASHBURN AVE STE 6
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-268-6995
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Fax | 951-268-6559
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Authorized Official
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Title or Position | CEO
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Name | MARITZA HARRISON
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Credential | FNP
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Telephone | 951-202-9083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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