Provider Demographics
NPI:1861599144
Name:MMR MEDICAL GROUP INC
Entity type:Organization
Organization Name:MMR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-992-3300
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0071
Mailing Address - Country:US
Mailing Address - Phone:559-992-3300
Mailing Address - Fax:559-992-8162
Practice Address - Street 1:1310 HANNA AVE
Practice Address - Street 2:STE 1
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2314
Practice Address - Country:US
Practice Address - Phone:559-992-3300
Practice Address - Fax:559-992-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089410Medicaid
CAZZZ21564ZMedicare ID - Type Unspecified