Organization
FACULTY MEDICAL GROUP OF LLUSM
Active
Parent organization
FACULTY MEDICAL GROUP OF LLUSM IND
Other names
FMG-ED MURRIETA
Organization subpart
Yes
Provider details
NPI number
Legal business name
FACULTY MEDICAL GROUP OF LLUSM IND
Authorized official
MS. LISA WOLTER (PROVIDER ENROLLMENT REP)
(909) 558-3289
Entity
Organization
Contact information
Practice address
28062 BAXTER ROAD, MURRIETA, CA 92563
(909) 558-3111
Mailing address
11165 MOUNTAIN VIEW AVE, STE 228, LOMA LINDA, CA 92354-3866
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
Other
Enumeration date
01/27/2011
Last updated
01/27/2011
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