MEDICARE: NATIONWIDE MEDICAL GROUP, INC

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	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629125059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONWIDE MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	7246 REMMET AVE
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1531
Country	:	US
Telephone Number	:	818-206-0360
Fax Number	:	818-206-0383

Provider Business Practice Location Address
First Line	:	2321 PONTIUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1809
Country	:	US
Telephone Number	:	310-478-8066
Fax Number	:	310-478-8821

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. GEORGE GIRGIS
Credential	:	M.D.
Telephone Number	:	661-861-9967

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/14/2008

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