Active NPI 1154688810 Individual Practitioner Male Practitioner

Dr. Maxwell Jen , MD

Emergency Medicine • Tustin, CA

✓ Accepts Medicare Assignment Telehealth Available

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Maxwell Jen, MD is a registered Emergency Medicine practitioner in Tustin, CA. With approximately 14 years of clinical practice since graduating from University Of California, San Francisco School Of Medicine in 2012, Dr. Jen provides healthcare services at the registered practice location at 17400 IRVINE BLVD STE N.

Dr. Jen maintains professional affiliations with Vital Medical Group Inc, Remedial Patients Care Inc, Regents Of The University Of and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow, prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service);, advance care planning, first. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

17400 Irvine Blvd Ste N

Tustin, CA 927803030

Telephone 1111111111

Associated Practice Facility / Clinic

🏢 17th Street Optometry Apc Facility NPI 1891268678

Medicare Profile & Education

Medical School

University Of California, San Francisco School Of Medicine

Graduation Year

2012

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Emergency Medicine in Tustin, CA

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

14 Yrs -19.5 yrs vs City Avg

City Avg: 33.5 Yrs

State Avg: 22.9 Yrs

Regional Practice Density

6 Specialists

Practicing in Tustin, CA (7995 Statewide)

Telehealth Adoption Rate

16.7% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

42.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Jen (14 Years) 14 Yrs

Tustin Specialty Average (33.5 Years) 33.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	2,813	690	$157.74	$108.96
G0318 Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualif	1,769	911	$50.00	$32.27
99497 Advance care planning, first 30 minutes	1,733	1,053	$135.26	$86.36
99350 Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes	1,328	607	$275.08	$192.41
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	648	452	$76.12	$44.84
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	627	555	$95.12	$56.84
99345 Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes	484	484	$325.42	$210.11
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	230	152	$60.04	$28.62
93040 Tracing of electrical activity of heart using 1-3 leads with interpretation and report	191	147	$27.40	$13.92
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	186	186	$195.02	$139.51
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	174	174	$252.75	$175.55
G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or	161	84	$40.00	$33.92
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	144	70	$255.01	$193.63
99285 Emergency department visit for life threatening or functioning severity	122	119	$754.00	$176.10
99483 Assessment of and care planning for patient with impaired thought processing, typically 50 minutes	106	105	$350.47	$293.65
93924 Ultrasound study of arteries of both legs at rest and exercise	99	98	$245.00	$181.92
95930 Measurement of nerve conduction using visual stimulation testing with report	96	96	$98.00	$73.94
96139 Administration of psychological or neuropsychological test by technician, each additional 30 minutes	96	96	$53.00	$39.51
96132 Evaluation of neuropsychological test, first hour	95	95	$138.02	$132.83
96138 Administration of psychological or neuropsychological test by technician, first 30 minutes	95	95	$50.00	$38.38
93923 Complete ultrasound study of arm and leg arteries	87	86	$200.00	$147.87
95816 Measurement of brain wave activity (eeg), awake and drowsy	73	73	$580.07	$434.83
92653 Evaluation of brain response to sound for diagnosis of nervous system disorders with interpretation and report	73	73	$115.15	$87.90
95957 Digital analysis of electrical brain wave activity (EEG)	73	73	$422.00	$318.07
99284 Emergency department visit with moderate level of medical decision making	71	65	$518.00	$121.77
99344 New patient home visit, typically 1 hour	67	67	$280.33	$147.25
95923 Testing of autonomic (sympathetic) nervous system function	66	65	$200.63	$135.97
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	54	54	$335.00	$192.58
95924 Testing of autonomic (sympathetic and parasympathetic) nervous system function, at least 5 minutes of tilt	51	51	$220.00	$166.04
76770 Complete ultrasound scan behind abdominal cavity	44	43	$200.14	$121.76
76536 Ultrasound of head and neck	44	44	$210.00	$124.99
93925 Ultrasound of leg arteries or artery grafts	44	43	$450.00	$275.05
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	43	38	$192.50	$132.06
93970 Ultrasound study of arm or leg veins with compression and maneuvers	42	41	$350.00	$168.54
93880 Ultrasound of both sides of head and neck blood flow	33	33	$360.12	$215.08
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	32	32	$320.00	$234.45
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	28	28	$365.00	$202.97
76700 Ultrasound of abdomen	25	25	$220.00	$131.13
99291 Critical care, first 30-74 minutes	23	23	$963.00	$216.98
76872 Ultrasound scan of pelvic region through rectum	22	22	$280.00	$157.37
95921 Testing of autonomic nervous system function and heart rate response to deep breathing	16	16	$124.72	$96.72
93922 Ultrasound study of arm and leg arteries	11	11	$135.00	$77.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	2,569	598	$158.49	$109.37
G0318 Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualif	1,683	733	$50.00	$32.97
99350 Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes	1,438	584	$274.79	$196.84
99497 Advance care planning, first 30 minutes	1,200	733	$135.21	$88.47
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	621	508	$95.12	$55.70
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	575	394	$76.12	$44.58
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	246	114	$60.04	$29.42
99345 Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes	172	172	$322.17	$216.96
93040 Tracing of electrical activity of heart using 1-3 leads with interpretation and report	161	159	$50.00	$14.04
95921 Testing of autonomic nervous system function and heart rate response to deep breathing	154	152	$124.72	$98.38
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	151	95	$192.47	$135.12
93922 Ultrasound study of arm and leg arteries	147	145	$135.00	$91.19
95923 Testing of autonomic (sympathetic) nervous system function	144	141	$200.63	$140.67
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	141	141	$195.02	$140.74
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	116	116	$252.67	$180.14
99284 Emergency department visit with moderate level of medical decision making	73	73	$518.00	$126.81
99344 New patient home visit, typically 1 hour	66	66	$280.36	$152.80
93925 Ultrasound of leg arteries or artery grafts	64	64	$450.00	$279.23
93970 Ultrasound study of arm or leg veins with compression and maneuvers	64	64	$350.00	$173.20
99285 Emergency department visit for life threatening or functioning severity	63	63	$754.00	$184.11
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	57	47	$254.91	$193.67
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	48	48	$320.00	$236.67
76700 Ultrasound of abdomen	43	41	$220.00	$134.14
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	40	38	$335.00	$198.38
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	39	39	$365.00	$211.85
93880 Ultrasound of both sides of head and neck blood flow	33	33	$360.00	$219.62
76770 Complete ultrasound scan behind abdominal cavity	29	27	$200.00	$124.99
99291 Critical care, first 30-74 minutes	29	28	$963.00	$226.02
99483 Assessment of and care planning for patient with impaired thought processing, typically 50 minutes	19	19	$400.00	$296.16
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$255.00	$179.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	17	14	$180.00	$138.65
76604 Ultrasound scan of chest	16	16	$126.00	$28.46
76872 Ultrasound scan of pelvic region through rectum	15	15	$280.00	$158.33
99283 Emergency department visit with low level of medical decision making	13	13	$305.00	$75.31
76705 Limited ultrasound scan of abdomen	13	13	$129.00	$30.38
93308 Ultrasound of heart, follow-up	12	12	$118.00	$26.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	1,110	363	$159.50	$112.06
99354 Prolonged office or other outpatient service first hour	619	356	$195.09	$136.37
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	495	271	$192.10	$136.43
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	339	301	$93.94	$57.46
99497 Advance care planning, first 30 minutes	256	244	$135.29	$91.09
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	180	161	$73.58	$44.60
99344 New patient home visit, typically 1 hour	126	126	$279.46	$190.60
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	105	65	$59.79	$30.55
99285 Emergency department visit for life threatening or functioning severity	52	51	$754.00	$184.41
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	51	51	$252.55	$180.98
93040 Tracing of electrical activity of heart using 1-3 leads with interpretation and report	40	40	$45.82	$14.03
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	38	38	$195.02	$142.89
99284 Emergency department visit with moderate level of medical decision making	36	36	$518.00	$127.47
95923 Testing of autonomic (sympathetic) nervous system function	36	36	$198.41	$147.11
95921 Testing of autonomic nervous system function and heart rate response to deep breathing	36	36	$123.89	$102.10
93922 Ultrasound study of arm and leg arteries	18	18	$135.00	$96.89
93042 Interpretation and report of electrical activity of heart using 1-3 leads	17	15	$31.00	$7.26
99291 Critical care, first 30-74 minutes	11	11	$963.00	$228.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	1,239	421	$152.22	$112.02
99354 Prolonged office or other outpatient service first hour	681	428	$177.64	$139.98
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	438	281	$181.20	$140.09
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	377	351	$76.11	$56.70
99497 Advance care planning, first 30 minutes	230	218	$125.40	$93.28
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	197	173	$58.01	$43.97
99344 New patient home visit, typically 1 hour	167	167	$257.98	$195.47
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	104	95	$128.15	$90.59
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	102	77	$49.57	$31.46
93040 Tracing of electrical activity of heart using 1-3 leads with interpretation and report	69	69	$19.06	$14.32
93922 Ultrasound study of arm and leg arteries	62	62	$127.22	$101.37
95923 Testing of autonomic (sympathetic) nervous system function	62	62	$184.98	$153.42
95921 Testing of autonomic nervous system function and heart rate response to deep breathing	59	58	$116.33	$103.05
99284 Emergency department visit with moderate level of medical decision making	46	45	$511.26	$130.42
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	46	46	$199.96	$147.66
99285 Emergency department visit for life threatening or functioning severity	40	40	$742.10	$189.90
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	26	26	$242.75	$186.69
99291 Critical care, first 30-74 minutes	16	16	$963.00	$235.39
99283 Emergency department visit with low level of medical decision making	14	14	$289.00	$76.77
93042 Interpretation and report of electrical activity of heart using 1-3 leads	13	13	$31.00	$7.45
99343 New patient home visit, typically 45 minutes	11	11	$182.05	$136.28

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	465	141	$152.28	$113.89
99354 Prolonged office or other outpatient service first hour	451	285	$183.83	$142.99
99344 New patient home visit, typically 1 hour	202	202	$258.33	$200.26
99497 Advance care planning, first 30 minutes	199	199	$121.22	$94.51
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	174	111	$182.50	$142.23
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	119	93	$118.04	$91.83
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	110	109	$76.12	$56.92
99285 Emergency department visit for life threatening or functioning severity	84	84	$737.00	$185.09
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	82	76	$58.59	$43.81
99284 Emergency department visit with moderate level of medical decision making	78	73	$502.97	$127.59
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	61	45	$41.04	$31.96
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	61	61	$165.02	$130.31
93042 Interpretation and report of electrical activity of heart using 1-3 leads	59	57	$30.25	$7.66
99343 New patient home visit, typically 45 minutes	50	50	$182.05	$140.53
95923 Testing of autonomic (sympathetic) nervous system function	47	47	$187.05	$150.29
93922 Ultrasound study of arm and leg arteries	47	47	$124.10	$100.66
93040 Tracing of electrical activity of heart using 1-3 leads with interpretation and report	47	47	$18.20	$14.37
99291 Critical care, first 30-74 minutes	47	47	$963.00	$240.15
95921 Testing of autonomic nervous system function and heart rate response to deep breathing	47	47	$124.20	$98.95
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	35	35	$242.75	$191.01
99283 Emergency department visit with low level of medical decision making	35	35	$266.97	$69.53
99217 Hospital observation care on day of discharge	12	12	$320.00	$79.59
76604 Ultrasound scan of chest	11	11	$121.64	$30.35

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99285 Emergency department visit for life threatening or functioning severity	126	123	$737.00	$181.42
93042 Interpretation and report of electrical activity of heart using 1-3 leads	99	83	$30.00	$7.52
99284 Emergency department visit with moderate level of medical decision making	80	80	$500.00	$123.42
99291 Critical care, first 30-74 minutes	42	42	$963.00	$235.89
99283 Emergency department visit with low level of medical decision making	38	36	$264.00	$63.92
76705 Limited ultrasound scan of abdomen	23	23	$129.00	$31.54
93308 Ultrasound of heart, follow-up	19	19	$112.00	$27.79
76604 Ultrasound scan of chest	19	19	$118.00	$27.98
76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	13	13	$108.00	$26.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99285 Emergency department visit for life threatening or functioning severity	116	113	$737.00	$179.00
99284 Emergency department visit with moderate level of medical decision making	98	96	$500.00	$122.80
93042 Interpretation and report of electrical activity of heart using 1-3 leads	69	60	$30.00	$7.47
99283 Emergency department visit with low level of medical decision making	51	48	$264.00	$64.84
99291 Critical care, first 30-74 minutes	27	27	$963.00	$235.28
76705 Limited ultrasound scan of abdomen	21	21	$129.00	$31.77
76604 Ultrasound scan of chest	21	21	$118.00	$27.59
93308 Ultrasound of heart, follow-up	19	19	$112.00	$27.63
99217 Hospital observation care on day of discharge	15	15	$320.00	$75.81
99220 Hospital observation care, typically 70 minutes	14	14	$809.00	$198.93

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99285 Emergency department visit for life threatening or functioning severity	206	200	$733.28	$181.28
99284 Emergency department visit with moderate level of medical decision making	150	146	$497.31	$123.15
93042 Interpretation and report of electrical activity of heart using 1-3 leads	128	121	$30.00	$7.49
99283 Emergency department visit with low level of medical decision making	48	48	$272.33	$65.04
99291 Critical care, first 30-74 minutes	30	30	$959.13	$237.04
76604 Ultrasound scan of chest	25	25	$118.84	$27.78
93308 Ultrasound of heart, follow-up	23	23	$112.00	$27.66
76705 Limited ultrasound scan of abdomen	23	23	$128.17	$31.86
99217 Hospital observation care on day of discharge	12	12	$317.25	$78.77

Medical Specialties & State Licenses

CMS Verified: 2020-08-18

Emergency Medicine Primary Specialty

NUCC Taxonomy Code: 207P00000X

State License CA A130209

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Hospital & Practice Group Affiliations

Vital Medical Group Inc

1314 W Glenoaks Blvd, Glendale, CA 912014890

Phone: 8183965158

Remedial Patients Care Inc

1451 Rimpau Ave, Corona, CA 928797522

Phone: 9512686272

Regents Of The University Of

101 The City Dr S, Orange, CA 928683201

Phone: 7144567004

Secondary Practice Locations

333 City Blvd W, Suite 640, Rt. 128-01

Orange, CA 928682903

Phone: 7144565922

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Sonia Mays , LCSW

Social Worker - Clinical

NPI 1003169954

Licensed Clinical Social Worker

Cynthia Kyle

Developmental Therapist

NPI 1003172289

Lorraine Danowski , RD

Dietitian, Registered

NPI 1043251085

Registered Dietitian

Dr. Wen-Min Chuu , MD

Internal Medicine - Hematology & Oncology

NPI 1063481679

Doctor of Medicine (M.D.)

Kathleen Flynn

Counselor

NPI 1063804375

Dr. Kenneth Mueller , PharmD

Pharmacist

NPI 1073829859

Doctor of Pharmacy (Pharm.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

📍

Updated Practice Location September 03, 2020

Registered at 17400 IRVINE BLVD STE N, TUSTIN, CA 927803030 (Tel: 1111111111)

📍

Updated Practice Location July 15, 2020

Registered at 1073 ROSS AVE STE D, EL CENTRO, CA 922434371 (Tel: 7609704361)

📍

Updated Business Mailing Address July 15, 2020

Registered at 24060 FIR AVE STE A-1, MORENO VALLEY, CA 925532895

✅

NPI Profile Active June 04, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location June 04, 2015

Registered at 333 CITY BLVD W, SUITE 640, RT. 128-01, ORANGE, CA 928682903 (Tel: 7144565922)

📍

Updated Business Mailing Address June 04, 2015

Registered at 333 CITY BLVD W, SUITE 640, RT. 128-01, ORANGE, CA 928682903 (Tel: 7144565922)

👤

Provider Name / Credentials Updated June 04, 2015

Recorded as MAXWELL JEN, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 04, 2015

Emergency Medicine (License #A130209 in CA)

🟢

Initial NPI Registration & Enumeration April 19, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1154688810

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 19, 2012

Last Update: December 06, 2021

Sole Proprietor: No

Update or Correct Profile

Mailing Address

24060 Fir Ave Ste A-1

Moreno Valley, CA 925532895

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.