Healthcare Provider Details

I. General information

NPI: 1659472025
Provider Name (Legal Business Name): SORIN EREMIA M D INC A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROCKTON AVE SUITE 200
RIVERSIDE CA
92501-4068
US

IV. Provider business mailing address

4440 BROCKTON AVE SUITE 200
RIVERSIDE CA
92501-4068
US

V. Phone/Fax

Practice location:
  • Phone: 951-275-0988
  • Fax: 951-275-9223
Mailing address:
  • Phone: 951-275-0988
  • Fax: 951-275-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG42033
License Number StateCA

VIII. Authorized Official

Name: DR. SORIN EREMIA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 951-275-0988