Healthcare Provider Details

I. General information

NPI: 1063191575
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA EMERGENCY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 LA SIERRA AVE
RIVERSIDE CA
92503-5204
US

IV. Provider business mailing address

1407 FOOTHILL BLVD # 14
LA VERNE CA
91750-3451
US

V. Phone/Fax

Practice location:
  • Phone: 951-429-6002
  • Fax:
Mailing address:
  • Phone: 909-596-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER BRUNK
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 909-596-6349