MEDICARE: INSCRIPTIONS CHILDREN'S CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	1669	CA
2	363LP0200X	Pediatric Nurse Practitioner	16134	CA
3	208000000X	Pediatrics Physician	20A9032	CA

General Provider Information

NPI Number	:	1235431172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSCRIPTIONS CHILDREN'S CLINIC

Provider Business Mailing Address
First Line	:	36243 INLAND VALLEY DR
Second Line	:	SUITE #80
City	:	WILDOMAR
State	:	CA
Zip	:	92595-9549
Country	:	US
Telephone Number	:	951-813-3760
Fax Number	:	951-813-3761

Provider Business Practice Location Address
First Line	:	36243 INLAND VALLEY DR
Second Line	:	SUITE #80
City	:	WILDOMAR
State	:	CA
Zip	:	92595-9549
Country	:	US
Telephone Number	:	951-813-3760
Fax Number	:	951-813-3761

Authorized Official
Title or Position	:	PEDIATRICS
Name	:	MRS. MARIAM W FAHIM
Credential	:	D.O
Telephone Number	:	951-813-3760

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	08/18/2014

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