Organization
CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
Active
Parent organization
CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
Authorized official
HERBERT MARSHAK M.D. (MEDICAL DIRECTOR)
(951) 286-6036
Entity
Organization
Contact information
Practice address
3211 VAN BUREN BLVD STE B, RIVERSIDE, CA 92503-5640
(951) 286-6036
Mailing address
2980 N BEVERLY GLEN CIR, STE 100, LOS ANGELES, CA 90077-1726
(310) 474-9809
(888) 431-8819
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
01/12/2011
Last updated
10/05/2015
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