Healthcare Provider Details

I. General information

NPI: 1144071887
Provider Name (Legal Business Name): NEW SOCAL MEDICAL GROUP PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 N SAN JACINTO ST STE A
HEMET CA
92543-3105
US

IV. Provider business mailing address

15972 TUSCOLA RD STE 101
APPLE VALLEY CA
92307-2106
US

V. Phone/Fax

Practice location:
  • Phone: 469-277-2184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARSHAN PATEL
Title or Position: CO OWNER
Credential: MD
Phone: 951-540-6610