Provider Demographics
NPI:1942620471
Name:HQ PHYSICAL MEDICINE CORP.
Entity Type:Organization
Organization Name:HQ PHYSICAL MEDICINE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:THERMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO, DE
Authorized Official - Phone:888-564-2081
Mailing Address - Street 1:125 COLUMBIA
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656
Mailing Address - Country:US
Mailing Address - Phone:888-564-2081
Mailing Address - Fax:
Practice Address - Street 1:125 COLUMBIA
Practice Address - Street 2:SUITE A
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:888-564-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty