Healthcare Provider Details

I. General information

NPI: 1467024331
Provider Name (Legal Business Name): ALERTIVE HEALTHCARE MEDICAL GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 305
RIVERSIDE CA
92501-4027
US

IV. Provider business mailing address

32605 TEMECULA PKWY STE 205
TEMECULA CA
92592-6839
US

V. Phone/Fax

Practice location:
  • Phone: 206-445-9978
  • Fax:
Mailing address:
  • Phone: 206-445-9978
  • Fax:

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: SIVARAMAN K GOUNDER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-762-2485