Healthcare Provider Details

I. General information

NPI: 1154307460
Provider Name (Legal Business Name): HEMET VALLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax: 951-766-6471
Mailing address:
  • Phone: 951-652-2811
  • Fax: 951-766-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHSP50382
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE KELSO
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 951-925-6339