Healthcare Provider Details

I. General information

NPI: 1255849360
Provider Name (Legal Business Name): CALIFORNIA UNIVERSITY OF SCIENCE AND MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

1501 VIOLET ST
COLTON CA
92324-1603
US

V. Phone/Fax

Practice location:
  • Phone: 855-422-8029
  • Fax: 855-422-8029
Mailing address:
  • Phone: 909-566-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL LYONS
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 909-566-2669