Provider Demographics
NPI:1992407381
Name:HUMANITY MEDICAL GROUP INC.
Entity type:Organization
Organization Name:HUMANITY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-521-3624
Mailing Address - Street 1:1720 E LOS ANGELES AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5813
Mailing Address - Country:US
Mailing Address - Phone:805-980-7574
Mailing Address - Fax:805-426-8781
Practice Address - Street 1:1720 E LOS ANGELES AVE STE 231
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5813
Practice Address - Country:US
Practice Address - Phone:805-980-7574
Practice Address - Fax:805-426-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty