Provider Demographics
NPI:1073824199
Name:MOWBRAY P HAGAN, MD, INC
Entity Type:Organization
Organization Name:MOWBRAY P HAGAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOWBRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-6110
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:482 CORONA MALL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1418
Practice Address - Country:US
Practice Address - Phone:951-734-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOWBRAY P HAGAN, MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site