Healthcare Provider Details

I. General information

NPI: 1114339207
Provider Name (Legal Business Name): PARKVIEW MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE SUITE 107
RIVERSIDE CA
92503-3900
US

IV. Provider business mailing address

9041 MAGNOLIA AVE SUITE 107
RIVERSIDE CA
92503-3900
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-1021
  • Fax: 951-687-0692
Mailing address:
  • Phone: 951-353-1021
  • Fax: 951-687-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CHAPMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-353-1021