Provider Demographics
NPI:1629785910
Name:CHOICE HEALTH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHOICE HEALTH MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-951-0908
Mailing Address - Street 1:408 S BEACH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1871
Mailing Address - Country:US
Mailing Address - Phone:714-826-8800
Mailing Address - Fax:833-593-2722
Practice Address - Street 1:408 S BEACH BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1871
Practice Address - Country:US
Practice Address - Phone:714-826-8800
Practice Address - Fax:833-593-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty