Provider Demographics
NPI:1629528682
Name:NEWHIDE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NEWHIDE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUHA
Authorized Official - Middle Name:RAYYIS
Authorized Official - Last Name:NEWHIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-314-2255
Mailing Address - Street 1:4950 SAN BERNARDINO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:951-314-2255
Mailing Address - Fax:
Practice Address - Street 1:4950 SAN BERNARDINO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:951-314-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty