Provider Demographics
NPI:1902140734
Name:HYGEIA II MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:HYGEIA II MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKFOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-515-7571
Mailing Address - Street 1:6241 YARROW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1541
Mailing Address - Country:US
Mailing Address - Phone:714-515-7571
Mailing Address - Fax:714-494-8571
Practice Address - Street 1:6241 YARROW DR
Practice Address - Street 2:SUITE A
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011
Practice Address - Country:US
Practice Address - Phone:714-515-7571
Practice Address - Fax:714-494-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77989Medicaid