Provider Demographics
NPI:1760360523
Name:PHYSICIAN ASSOCIATES MEDICAL GROUP
Entity type:Organization
Organization Name:PHYSICIAN ASSOCIATES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING/CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIAL
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:951-545-2442
Mailing Address - Street 1:9950 RESEARCH DR STE A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9950 RESEARCH DR STE A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4309
Practice Address - Country:US
Practice Address - Phone:714-313-1493
Practice Address - Fax:951-225-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center