Provider Demographics
NPI:1760743454
Name:MURRIETA VALLEY SURGERY ASSOCIATES MEDICAL GROUP, INC, APC
Entity Type:Organization
Organization Name:MURRIETA VALLEY SURGERY ASSOCIATES MEDICAL GROUP, INC, APC
Other - Org Name:MURRIETA VALLEY SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-698-3000
Mailing Address - Street 1:36320 INLAND VALLEY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-698-3000
Mailing Address - Fax:951-698-7700
Practice Address - Street 1:36320 INLAND VALLEY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-698-3000
Practice Address - Fax:951-698-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60487208600000X
CAA68155208600000X
CAA55612208600000X
CAA60160208600000X
CAA681542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty