Provider Demographics
NPI:1093869083
Name:ARROYO SECO MEDICAL GROUP
Entity Type:Organization
Organization Name:ARROYO SECO MEDICAL GROUP
Other - Org Name:ARROYO VERDE MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-7556
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:626-795-7556
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2561
Practice Address - Country:US
Practice Address - Phone:626-795-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14920Medicare PIN
CAW14920BMedicare PIN
CAW14920AMedicare PIN