Healthcare Provider Details

I. General information

NPI: 1992162911
Provider Name (Legal Business Name): GORDIAN MEDICAL IV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 CENTRAL AVE, FLOOR 4 SUITE 40
RIVERSIDE CA
92506-5900
US

IV. Provider business mailing address

750 THE CITY DR S STE 225
ORANGE CA
92868-4976
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-9000
  • Fax: 877-380-8282
Mailing address:
  • Phone: 714-556-0200
  • Fax: 877-380-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 714-556-0200