Healthcare Provider Details

I. General information

NPI: 1184108797
Provider Name (Legal Business Name): PATRICK W UTNEHMER A PROFFESIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41493 MARGARITA RD STE G109
TEMECULA CA
92591-5570
US

IV. Provider business mailing address

41493 MARGARITA RD STE G109
TEMECULA CA
92591-5570
US

V. Phone/Fax

Practice location:
  • Phone: 951-541-7157
  • Fax: 951-296-2211
Mailing address:
  • Phone: 951-541-7157
  • Fax: 951-296-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK W UTNEHMER
Title or Position: OWNER
Credential:
Phone: 951-541-3427