Basic Information
| Provider Information | |||||||||
| NPI: | 1023293602 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | U.S. HEALTHWORKS MEDICAL GROUP, PROF. CORP. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WORKFORCE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5575 RUFFIN RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585651300 | ||||||||
| FaxNumber: | 8585656932 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 ARCH ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940621305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505569420 | ||||||||
| FaxNumber: | 6505689053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 11/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | OKUN | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8585651300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.