Provider Demographics
NPI:1144644766
Name:POSEIDON MEDICAL GROUP, INC
Entity type:Organization
Organization Name:POSEIDON MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JARMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-505-2093
Mailing Address - Street 1:PO BOX 6646
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6646
Mailing Address - Country:US
Mailing Address - Phone:714-505-2093
Mailing Address - Fax:
Practice Address - Street 1:3404 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3253
Practice Address - Country:US
Practice Address - Phone:951-782-8369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0513832083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty