Provider Demographics
NPI:1992712186
Name:MUTH & WEBER OB/GYN MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MUTH & WEBER OB/GYN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-5380
Mailing Address - Street 1:2888 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1530
Mailing Address - Country:US
Mailing Address - Phone:562-595-5380
Mailing Address - Fax:562-595-0464
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:SUITE 165
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-5380
Practice Address - Fax:562-595-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25796207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15338Medicare ID - Type UnspecifiedCORPORATE MEDICARE NUMBER