MEDICARE: HONORHEALTH MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1346050556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONORHEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 845635
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-5635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 N 83RD AVE UNIT 210
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-849-3811
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	JOHN NEIL
Credential	:
Telephone Number	:	480-587-5123

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	01/09/2025

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