Provider Demographics
NPI:1689036121
Name:TRUE DOC MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:TRUE DOC MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOWBRAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-6110
Mailing Address - Street 1:2469 POMONA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6928
Mailing Address - Country:US
Mailing Address - Phone:202-285-7881
Mailing Address - Fax:951-737-1167
Practice Address - Street 1:770 MAGNOLIA AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:951-737-0110
Practice Address - Fax:951-737-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544451261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center