Provider Demographics
NPI:1902830250
Name:FOUR SEASONS MEDICAL GROUP
Entity Type:Organization
Organization Name:FOUR SEASONS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-260-9890
Mailing Address - Street 1:1314 S EUCLID ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2079
Mailing Address - Country:US
Mailing Address - Phone:714-849-3777
Mailing Address - Fax:
Practice Address - Street 1:1314 S EUCLID ST
Practice Address - Street 2:STE. 104
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2079
Practice Address - Country:US
Practice Address - Phone:714-849-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30523207R00000X
NV3264207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty