Healthcare Provider Details

I. General information

NPI: 1275018392
Provider Name (Legal Business Name): PLATINUM PROVIDERS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 BROCKTON AVE STE 100
RIVERSIDE CA
92506-3817
US

IV. Provider business mailing address

2250 S MAIN ST STE 209
CORONA CA
92882-2507
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3800
  • Fax: 951-781-1973
Mailing address:
  • Phone: 951-781-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT G NELSON
Title or Position: PRESIDENT
Credential: MD
Phone: 951-737-8141