Provider Demographics
NPI:1184999385
Name:NATION MANAGEMENT GROUP INC
Entity type:Organization
Organization Name:NATION MANAGEMENT GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-690-3210
Mailing Address - Street 1:1261 N LAKEVIEW AVE STE J
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1859
Mailing Address - Country:US
Mailing Address - Phone:949-690-3210
Mailing Address - Fax:949-690-3215
Practice Address - Street 1:1261 N LAKEVIEW AVE STE J
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1859
Practice Address - Country:US
Practice Address - Phone:949-690-3210
Practice Address - Fax:949-690-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center