Provider Demographics
NPI:1770664286
Name:MEDENWALD HOGG, JANET RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:RUTH
Last Name:MEDENWALD HOGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:RUTH
Other - Last Name:MEDENWALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18555 AVENIDA ESCALERA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8611
Mailing Address - Country:US
Mailing Address - Phone:831-346-8236
Mailing Address - Fax:831-454-4663
Practice Address - Street 1:STEP UP ON SECOND; 600 N. ARROWHEAD AVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1152
Practice Address - Country:US
Practice Address - Phone:909-963-5355
Practice Address - Fax:909-453-3205
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG584222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58422OtherMEDICAL LICENSE #
CAZZZ91891ZOtherMEDICARE GROUP ID#
CAZZZ91892ZOtherMEDICARE GROUP ID#
CAZZZ92069ZOtherMEDICARE GROUP ID#
CABP973Medicaid
CA00G584220Medicaid
CA00G584220Medicaid
CAG58422OtherMEDICAL LICENSE #