Basic Information
| Provider Information | |||||||||
| NPI: | 1932256336 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONWIDE MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7246 REMMET AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913031531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182060360 | ||||||||
| FaxNumber: | 8182060383 | ||||||||
| Practice Location | |||||||||
| Address1: | 4129 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059644795 | ||||||||
| FaxNumber: | 8056833027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | GIRGIS | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6618619967 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | GR008716N | 05 | CA | MEDICAID |