Healthcare Provider Details

I. General information

NPI: 1134629298
Provider Name (Legal Business Name): CORONA REGIONAL EMERGENCY MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882
US

IV. Provider business mailing address

PO BOX 80174
CITY OF INDUSTRY CA
91716-8174
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax: 310-379-4856
Mailing address:
  • Phone: 310-698-5452
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK BELL
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143