Basic Information
| Provider Information | |||||||||
| NPI: | 1477509974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HYGEIA MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1319 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953681319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095436279 | ||||||||
| FaxNumber: | 2095436280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 ROYALTY DR | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917673032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096231266 | ||||||||
| FaxNumber: | 9096233911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PAPPOE | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MD | ||||||||
| AuthorizedOfficialTelephone: | 9096231266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A76587 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A76587 | 01 | CA | LICENSE | OTHER |