Healthcare Provider Details

I. General information

NPI: 1013369883
Provider Name (Legal Business Name): MERRYCURE MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18064 WIKA RD STE 103
APPLE VALLEY CA
92307-2182
US

IV. Provider business mailing address

19878 SENECA RD
APPLE VALLEY CA
92307-5519
US

V. Phone/Fax

Practice location:
  • Phone: 760-906-9362
  • Fax: 760-503-0064
Mailing address:
  • Phone: 909-353-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAREK MOQATTASH
Title or Position: PRESIDENT
Credential:
Phone: 909-353-8821