Provider Demographics
NPI:1164467973
Name:MAGUIRE & WELSH MEDICAL GROUP
Entity Type:Organization
Organization Name:MAGUIRE & WELSH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-945-9333
Mailing Address - Street 1:7624 PAINTER AVE
Mailing Address - Street 2:#100
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2357
Mailing Address - Country:US
Mailing Address - Phone:562-945-9333
Mailing Address - Fax:562-945-8533
Practice Address - Street 1:7624 PAINTER AVE
Practice Address - Street 2:#100
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2357
Practice Address - Country:US
Practice Address - Phone:562-945-9333
Practice Address - Fax:562-945-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7501207Q00000X
CA20A4248207QG0300X
CA20A4272207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC64501Medicare UPIN
CAI14087Medicare UPIN
CAC64494Medicare UPIN
CAW14670Medicare PIN