Healthcare Provider Details

I. General information

NPI: 1902409840
Provider Name (Legal Business Name): SEVEN STAR MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W FLORIDA AVE
HEMET CA
92543-3817
US

IV. Provider business mailing address

41889 FLORIDA AVE
HEMET CA
92544-5042
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-1333
  • Fax:
Mailing address:
  • Phone: 951-652-8700
  • Fax: 888-827-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE COTA
Title or Position: OPERATIONS MANAGER
Credential: MSHA
Phone: 951-652-8700