Healthcare Provider Details

I. General information

NPI: 1346843422
Provider Name (Legal Business Name): SEVEN STAR MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 E FLORIDA AVE STE 104
HEMET CA
92544-4711
US

IV. Provider business mailing address

41889 FLORIDA AVE
HEMET CA
92544-5042
US

V. Phone/Fax

Practice location:
  • Phone: 951-414-4011
  • Fax: 951-414-4012
Mailing address:
  • Phone: 951-652-8700
  • Fax: 951-414-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE COTA
Title or Position: OPERATIONS MANAGER
Credential: MSHA
Phone: 951-929-8149