Healthcare Provider Details

I. General information

NPI: 1376661090
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA OCCUPATIONAL MEDICINE PROVIDERS, AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SPRUCE ST. STE. F,
RIVERSIDE CA
92507
US

IV. Provider business mailing address

1405 SPRUCE ST. STE. F,
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-2222
  • Fax: 951-682-2247
Mailing address:
  • Phone: 951-682-2222
  • Fax: 951-682-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number20A5845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A5845
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number20A5845
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number20A5845
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20A5845
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A5845
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5845
License Number StateCA

VIII. Authorized Official

Name: DR. SURESH H. SABNANI
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 951-682-2222