Provider Demographics
NPI:1235286907
Name:NATIONWIDE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:NATIONWIDE MEDICAL GROUP, INC
Other - Org Name:AEGIS MEDICAL SYSTEMS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-861-9967
Mailing Address - Street 1:7246 REMMET AVENUE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1531
Mailing Address - Country:US
Mailing Address - Phone:818-206-0360
Mailing Address - Fax:818-206-0383
Practice Address - Street 1:11776 MARIPOSA RD
Practice Address - Street 2:SUITE #103
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1622
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:760-956-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X
CA14837261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR008716MMedicaid
CAGR008716MMedicaid