1528850617 NPI number — BANZON MEDICAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528850617 NPI number — BANZON MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANZON MEDICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528850617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
936 BURTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92545-4782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-894-1300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOPE MEDICAL ARTS PLAZA 29798 ROAD
Provider Second Line Business Practice Location Address:
SUITE #106
Provider Business Practice Location Address City Name:
MENIFEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-301-3588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BANZON
Authorized Official First Name:
JOSE PAULO LUIGI
Authorized Official Middle Name:
AZARRAGA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-894-1300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)