Provider Demographics
NPI:1154746964
Name:HIZON MEDICAL CORPORATION
Entity type:Organization
Organization Name:HIZON MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-790-0107
Mailing Address - Street 1:25495 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4902
Mailing Address - Country:US
Mailing Address - Phone:951-790-0107
Mailing Address - Fax:951-667-1933
Practice Address - Street 1:25495 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4902
Practice Address - Country:US
Practice Address - Phone:951-790-0107
Practice Address - Fax:951-667-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55359207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI917BMedicare PIN