Healthcare Provider Details

I. General information

NPI: 1023326543
Provider Name (Legal Business Name): PLIEV MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1200
US

IV. Provider business mailing address

505 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1200
US

V. Phone/Fax

Practice location:
  • Phone: 909-424-0065
  • Fax:
Mailing address:
  • Phone: 909-424-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MAGOMED PLIEV
Title or Position: OWNER
Credential:
Phone: 909-424-0065