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NPI Code Detail

MEDICARE: SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC

MEDICARE: SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1376632281
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number : 951-244-3535
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number : 951-244-3535
Authorized Official
Title or Position : DIRECTOR
Name : DR. MOHAMMAD R DANESH
Credential : M.D.
Telephone Number : 951-244-3500
Provider Enumeration Date : 10/11/2006
Last Update Date : 09/02/2025

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Directions to “SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC ” Practice Location

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