Healthcare Provider Details

I. General information

NPI: 1164617940
Provider Name (Legal Business Name): TOTAL FAMILY MEDICAL CENTER OF LAKE ELSINORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 WINCHESTER RD SUITE 101
TEMECULA CA
92590-4808
US

IV. Provider business mailing address

41715 WINCHESTER RD SUITE 101
TEMECULA CA
92590-4808
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-4451
  • Fax:
Mailing address:
  • Phone: 951-308-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberG72993
License Number StateCA

VIII. Authorized Official

Name: DR. NA'IMAH D POWELL
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 951-308-4451