Healthcare Provider Details

I. General information

NPI: 1417904012
Provider Name (Legal Business Name): MISSION ANESTHESIA MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

PO BOX 148
CLAREMONT CA
91711-0148
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-4343
  • Fax:
Mailing address:
  • Phone: 909-985-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY RIEKER
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 909-985-2112