Basic Information
| Provider Information | |||||||||
| NPI: | 1659323293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | US HEALTHWORKS MEDICAL GROUP PC | ||||||||
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| OtherOrganizationName: | MURRIETA VALLEY PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5575 RUFFIN ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585651300 | ||||||||
| FaxNumber: | 8585656932 | ||||||||
| Practice Location | |||||||||
| Address1: | 25285 MADISON AVENUE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925628954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9506009070 | ||||||||
| FaxNumber: | 9516009177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | OKUN | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8585651300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S. HEALTHWORKS MEDICAL GROUP | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT 25605 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ04797Z | 01 | CA | BLUE SHIELD | OTHER |