Healthcare Provider Details

I. General information

NPI: 1912829904
Provider Name (Legal Business Name): VIRTUE IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 YNEZ RD STE 108
TEMECULA CA
92591-4619
US

IV. Provider business mailing address

27403 YNEZ RD STE 110
TEMECULA CA
92591-4615
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-7028
  • Fax:
Mailing address:
  • Phone: 951-394-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JEREMY GOMER
Title or Position: PRESIDENT
Credential: M.D
Phone: 951-394-7028