Basic Information
| Provider Information | |||||||||
| NPI: | 1538462320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINTERHAVEN EMERGENCY PHYSICIANS MEDICAL GROUP INC | ||||||||
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| Address1: | PO BOX 1090 | ||||||||
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| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908011090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624680227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 E 4TH ST | ||||||||
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| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919502026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194704141 | ||||||||
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| ProviderEnumerationDate: | 12/16/2010 | ||||||||
| LastUpdateDate: | 12/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | MARON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9252255837 | ||||||||
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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 | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.