| Legacy Md Medical Group Inc | |
|
222 E Cole Blvd Ste C Calexico CA 92231-3211 | |
| (760) 550-1685 | |
| (888) 631-5150 |
| Full Name | Legacy Md Medical Group Inc |
|---|---|
| Speciality | General Practice |
| Location | 222 E Cole Blvd Ste C, Calexico, California |
| Authorized Official Name and Position | John M Strong (PRESIDENT) |
| Authorized Official Contact | 7605501685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Md Medical Group Inc 222 E Cole Blvd Calexico CA 92231-3211 Ph: (760) 550-1685 | Legacy Md Medical Group Inc 222 E Cole Blvd Ste C Calexico CA 92231-3211 Ph: (760) 550-1685 |
| NPI Number | 1073210753 |
|---|---|
| Provider Enumeration Date | 02/13/2023 |
| Last Update Date | 02/13/2023 |
| Medicare PECOS PAC ID | 0446619738 |
|---|---|
| Medicare Enrollment ID | O20230705001455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073210753 | NPI | - | NPPES |
| 1043248719 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Harry D Elshire |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1376618389 PECOS PAC ID: 2163410721 Enrollment ID: I20040506000442 |
| Provider Name | Hoang M Ho |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275684847 PECOS PAC ID: 7214906759 Enrollment ID: I20040930000689 |
| Provider Name | Lawrence N Cooper |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1518939297 PECOS PAC ID: 4284603267 Enrollment ID: I20050418001321 |
| Provider Name | Juan Carlos Velazquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497812895 PECOS PAC ID: 2961591771 Enrollment ID: I20071201000200 |
| Provider Name | Michael N Rutman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245303122 PECOS PAC ID: 2860533056 Enrollment ID: I20100111000198 |
| Provider Name | Bryant Nguyen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1902085426 PECOS PAC ID: 4789756545 Enrollment ID: I20110815000304 |
| Provider Name | James M Kohan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063568947 PECOS PAC ID: 1658364302 Enrollment ID: I20120104000377 |
| Provider Name | Duc T Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1245495498 PECOS PAC ID: 8527115815 Enrollment ID: I20160222000135 |
| Provider Name | John Strong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043248719 PECOS PAC ID: 9335204163 Enrollment ID: I20170420001379 |
| Provider Name | Sohaib Tariq |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023391166 PECOS PAC ID: 6406124379 Enrollment ID: I20170616002455 |
| Provider Name | Alexis L Arreola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760035992 PECOS PAC ID: 4385076751 Enrollment ID: I20191125000234 |
| Provider Name | Christian Omar Romero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942806237 PECOS PAC ID: 2567878408 Enrollment ID: I20210301002401 |
| Provider Name | Jhoana B Tovar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649868191 PECOS PAC ID: 8224445440 Enrollment ID: I20210405001923 |
| Provider Name | Joanna Falcon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689254039 PECOS PAC ID: 9830591536 Enrollment ID: I20210716000820 |
| Provider Name | Rafid Asfar |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1639468747 PECOS PAC ID: 2961626486 Enrollment ID: I20211103001270 |
| Provider Name | Venus Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053705087 PECOS PAC ID: 0941577001 Enrollment ID: I20220712003771 |
| Provider Name | Steven J Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013658525 PECOS PAC ID: 7113397522 Enrollment ID: I20221229001537 |
| Provider Name | Benjamin Reisin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891952180 PECOS PAC ID: 3577924406 Enrollment ID: I20240131001429 |
| Provider Name | Javier Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770340515 PECOS PAC ID: 0749626604 Enrollment ID: I20240313003551 |
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