Healthcare Provider Details

I. General information

NPI: 1477999290
Provider Name (Legal Business Name): PEOPLES COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N SAN JACINTO ST SUITE Q
HEMET CA
92543-3154
US

IV. Provider business mailing address

540 N SAN JACINTO ST SUITE Q
HEMET CA
92543-3154
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-4000
  • Fax: 951-929-4100
Mailing address:
  • Phone: 951-929-4000
  • Fax: 951-929-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77862
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberA133706
License Number StateCA

VIII. Authorized Official

Name: HOURY KARABIBERJIAN
Title or Position: HR DIRECTOR/ADMIN
Credential:
Phone: 323-928-5052