Healthcare Provider Details

I. General information

NPI: 1164869780
Provider Name (Legal Business Name): 365 MDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE SUITE 302
RIVERSIDE CA
92503-3900
US

IV. Provider business mailing address

15777 S CLIFF CT
RIVERSIDE CA
92503-5493
US

V. Phone/Fax

Practice location:
  • Phone: 951-637-9999
  • Fax:
Mailing address:
  • Phone: 951-637-9999
  • Fax: 951-637-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-637-9999