Healthcare Provider Details

I. General information

NPI: 1053675793
Provider Name (Legal Business Name): ECLIPSE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE
CORONA CA
92879-3104
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD STE 234
ANAHEIM CA
92807-4760
US

V. Phone/Fax

Practice location:
  • Phone: 951-739-5944
  • Fax: 951-739-7480
Mailing address:
  • Phone: 714-282-5437
  • Fax: 714-282-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN LLOYD ISERI
Title or Position: OWNER
Credential: M.D.
Phone: 951-739-5944