Provider Demographics
NPI:1275690828
Name:SECURE HEALTH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SECURE HEALTH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-746-8698
Mailing Address - Street 1:1275 N ROSE DR
Mailing Address - Street 2:STE 126
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3919
Mailing Address - Country:US
Mailing Address - Phone:714-524-3880
Mailing Address - Fax:714-524-3884
Practice Address - Street 1:1275 N ROSE DR
Practice Address - Street 2:STE 126
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3919
Practice Address - Country:US
Practice Address - Phone:714-524-3880
Practice Address - Fax:714-524-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAA53412261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089650Medicaid
CAW15182Medicare PIN
CAGR0089650Medicaid