Healthcare Provider Details

I. General information

NPI: 1447908264
Provider Name (Legal Business Name): MD SENIOR CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BUSINESS PARK DR
PERRIS CA
92571-3165
US

IV. Provider business mailing address

99 BUSINESS PARK DR
PERRIS CA
92571-3165
US

V. Phone/Fax

Practice location:
  • Phone: 951-956-2131
  • Fax:
Mailing address:
  • Phone: 951-956-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAVID HERNANDEZ-RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 951-956-2131