Provider Demographics
NPI:1295028140
Name:HIZON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HIZON MEDICAL CORPORATION
Other - Org Name:MOTION SPORTS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-790-0107
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5987
Mailing Address - Country:US
Mailing Address - Phone:951-790-0107
Mailing Address - Fax:951-667-1933
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-790-0107
Practice Address - Fax:951-667-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty