Organization
FACULTY MEDICAL GROUP OF LLUSM
Active
Parent organization
FACULTY MEDICAL GROUP OF LLUSM
Other names
FMG OF LLUSM-ED URGENT CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
FACULTY MEDICAL GROUP OF LLUSM
Authorized official
MS. LISA WOLTER (PROVIDER ENROLLMENT REP)
(909) 558-3289
Entity
Organization
Contact information
Practice address
28078 BAXTER RD, MURRIETA, CA 92563
(951) 290-6366
(951) 290-6990
Mailing address
FILE NO 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
Other
Enumeration date
02/07/2011
Last updated
02/07/2011
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