1770664286 NPI number — DR. JANET RUTH MEDENWALD HOGG M.D.

Table of content: DR. JANET RUTH MEDENWALD HOGG M.D. (NPI 1770664286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770664286 NPI number — DR. JANET RUTH MEDENWALD HOGG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDENWALD HOGG
Provider First Name:
JANET
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDENWALD
Provider Other First Name:
JANET
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770664286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18555 AVENIDA ESCALERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-8611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-346-8236
Provider Business Mailing Address Fax Number:
831-454-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STEP UP ON SECOND; 600 N. ARROWHEAD AVE, SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92401-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-963-5355
Provider Business Practice Location Address Fax Number:
909-453-3205
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  G58422 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G58422 . This is a "MEDICAL LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91891Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91892Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ92069Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BP973 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G584220 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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