Healthcare Provider Details

I. General information

NPI: 1407964489
Provider Name (Legal Business Name): IDYLLWILD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54910 PINECREST AVE
IDYLLWILD CA
92549
US

IV. Provider business mailing address

PO BOX 3152
IDYLLWILD CA
92549-3152
US

V. Phone/Fax

Practice location:
  • Phone: 951-659-4908
  • Fax: 951-659-2984
Mailing address:
  • Phone: 951-659-4908
  • Fax: 951-659-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN QURESHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-659-4908