Healthcare Provider Details

I. General information

NPI: 1942860853
Provider Name (Legal Business Name): A J ROGERS, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 640
RIVERSIDE CA
92501-3314
US

IV. Provider business mailing address

32158 CAMINO CAPISTRANO STE A267
SAN JUAN CAPISTRANO CA
92675-3720
US

V. Phone/Fax

Practice location:
  • Phone: 951-744-4158
  • Fax: 951-742-5134
Mailing address:
  • Phone: 951-744-4158
  • Fax: 951-742-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: A J ROGERS
Title or Position: CEO
Credential: MD
Phone: 951-744-4158