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General NPI Number Information
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NPI Number | 1053675793
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Entity Type | Organization
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Legal Business Name | ECLIPSE MEDICAL GROUP
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE
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City | CORONA
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State | CA
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Zip | 92879-3104
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Country | US
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Telephone | 951-739-5944
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Fax | 951-739-7480
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Provider Business Mailing Address
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Address Line | 500 S ANAHEIM HILLS RD STE 234
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City | ANAHEIM
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State | CA
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Zip | 92807-4760
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Country | US
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Telephone | 714-282-5437
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Fax | 714-282-8724
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALLEN LLOYD ISERI
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Credential | M.D.
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Telephone | 951-739-5944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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