Healthcare Provider Details

I. General information

NPI: 1144644766
Provider Name (Legal Business Name): POSEIDON MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 ARLINGTON AVE
RIVERSIDE CA
92506-3253
US

IV. Provider business mailing address

PO BOX 6646
ORANGE CA
92863-6646
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-8369
  • Fax:
Mailing address:
  • Phone: 714-505-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA051383
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW JARMINSKI
Title or Position: PROVIDER
Credential: M.D.
Phone: 714-505-2093