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General NPI Number Information
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NPI Number | 1063191575
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA EMERGENCY MEDICINE
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 3480 LA SIERRA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92503-5204
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Country | US
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Telephone | 951-429-6002
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 FOOTHILL BLVD # 14
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City | LA VERNE
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State | CA
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Zip | 91750-3451
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Country | US
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Telephone | 909-596-6349
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Fax |
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Authorized Official
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Title or Position | CONTRACTING MANAGER
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Name | MRS. JENNIFER BRUNK
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Credential |
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Telephone | 909-596-6349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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