Healthcare Provider Details

I. General information

NPI: 1861853236
Provider Name (Legal Business Name): DRU IMRIE M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 S STATE ST
HEMET CA
92543-7976
US

IV. Provider business mailing address

1285 S STATE ST
HEMET CA
92543-7976
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-1777
  • Fax: 951-765-1772
Mailing address:
  • Phone: 951-765-1777
  • Fax: 951-765-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148882
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA148882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: