Healthcare Provider Details

I. General information

NPI: 1477647386
Provider Name (Legal Business Name): NAGASAMUDRA S ASHOK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W 7TH ST
SAN JACINTO CA
92583-4662
US

IV. Provider business mailing address

229 W 7TH ST
SAN JACINTO CA
92583-4662
US

V. Phone/Fax

Practice location:
  • Phone: 951-487-2550
  • Fax: 951-487-2552
Mailing address:
  • Phone: 951-487-2550
  • Fax: 951-487-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA41589
License Number StateCA

VIII. Authorized Official

Name: DR. NAGASAMUDRA S ASHOK
Title or Position: PRESIDENT
Credential: MD
Phone: 951-487-2550