Healthcare Provider Details

I. General information

NPI: 1740682822
Provider Name (Legal Business Name): HOME CARE PHYSICIAN SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE STE 302
RIVERSIDE CA
92503-3900
US

IV. Provider business mailing address

9041 MAGNOLIA AVE STE 302
RIVERSIDE CA
92503-3900
US

V. Phone/Fax

Practice location:
  • Phone: 951-756-3113
  • Fax:
Mailing address:
  • Phone: 951-756-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT NGUYEN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 951-756-3113