Healthcare Provider Details

I. General information

NPI: 1669669339
Provider Name (Legal Business Name): SAMEER OHRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 07/19/2022
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MAGNOLIA AVE STE 201
CORONA CA
92879-3128
US

IV. Provider business mailing address

818 MAGNOLIA AVE STE 201
CORONA CA
92879-3128
US

V. Phone/Fax

Practice location:
  • Phone: 951-356-9992
  • Fax: 951-595-4916
Mailing address:
  • Phone: 951-356-9992
  • Fax: 951-595-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA105886
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA105886
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA105886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: