Provider Demographics
NPI:1962755900
Name:MIND CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MIND CARE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GUADALUPE
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-833-0496
Mailing Address - Street 1:11351 BASKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2927
Mailing Address - Country:US
Mailing Address - Phone:562-430-3086
Mailing Address - Fax:
Practice Address - Street 1:1907 BOYS REPUBLIC DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5447
Practice Address - Country:US
Practice Address - Phone:909-628-1217
Practice Address - Fax:909-627-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A84702084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty