Healthcare Provider Details

I. General information

NPI: 1669891834
Provider Name (Legal Business Name): TEMECULA CENTER OF INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD 100
TEMECULA CA
92591-4671
US

IV. Provider business mailing address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-4333
  • Fax: 951-506-2361
Mailing address:
  • Phone: 951-383-4333
  • Fax: 951-506-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RICHARD FOX
Title or Position: CFO
Credential:
Phone: 619-370-1001